Provider Demographics
NPI:1962109819
Name:FIORDALISA R SANTIAGO LCSW PLLC
Entity type:Organization
Organization Name:FIORDALISA R SANTIAGO LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW-R
Authorized Official - Prefix:
Authorized Official - First Name:FIORDALISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:917-796-6315
Mailing Address - Street 1:2986 OTIS AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2138
Mailing Address - Country:US
Mailing Address - Phone:917-796-6315
Mailing Address - Fax:718-822-0902
Practice Address - Street 1:2986 OTIS AVE # 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2138
Practice Address - Country:US
Practice Address - Phone:917-796-6315
Practice Address - Fax:718-822-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty