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NPI Code Detail

MEDICARE: PHILLIP SANTIAGO

MEDICARE: PHILLIP SANTIAGO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YM0800XMental Health Counselor006800NY

General Provider Information

NPI Number : 1558622589
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP SANTIAGO
Provider Business Mailing Address
First Line : 1050 NIAGARA ST
Second Line :
City : BUFFALO
State : NY
Zip : 14213-2001
Country : US
Telephone Number : 716-856-2587
Fax Number :
Provider Business Practice Location Address
First Line : 1050 NIAGARA ST
Second Line :
City : BUFFALO
State : NY
Zip : 14213-2001
Country : US
Telephone Number : 716-856-2587
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 03/18/2021

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Directions to “ PHILLIP SANTIAGO ” Practice Location

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