Provider Demographics
NPI:1992106165
Name:SANTIAGO, ALEXANDRIA (LICSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PLEASANT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2021
Mailing Address - Country:US
Mailing Address - Phone:781-562-9159
Mailing Address - Fax:
Practice Address - Street 1:102 PLEASANT ST APT 2
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2021
Practice Address - Country:US
Practice Address - Phone:781-562-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2230051041C0700X
MA1249821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical