Provider Demographics
NPI:1699910844
Name:SANTIAGO MOIN, IRMA I (LCSW)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:I
Last Name:SANTIAGO MOIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HURD AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5017
Mailing Address - Country:US
Mailing Address - Phone:203-964-7941
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGH RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1202
Practice Address - Country:US
Practice Address - Phone:203-964-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical