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NPI Code Detail

MEDICARE: FIORDALISA R. SANTIAGO LCSW-R

MEDICARE: FIORDALISA R. SANTIAGO LCSW-R
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
11041C0700XClinical Social Worker058978NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1R058978OTHERNYNYS LICENSE

General Provider Information

NPI Number : 1801902036
Entity Type Code : Individual
Provider Name (Legal Business Name) : FIORDALISA R. SANTIAGO LCSW-R
Provider Business Mailing Address
First Line : 3485 E TREMONT AVE
Second Line :
City : BRONX
State : NY
Zip : 10465-2016
Country : US
Telephone Number : 718-828-1549
Fax Number : 718-828-5029
Provider Business Practice Location Address
First Line : 6214 RIVERDALE AVE
Second Line : STE 2C
City : BRONX
State : NY
Zip : 10471-1032
Country : US
Telephone Number : 917-796-6315
Fax Number : 866-490-9850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 02/10/2023

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Directions to “ FIORDALISA R. SANTIAGO LCSW-R” Practice Location

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