Healthcare Provider Details

I. General information

NPI: 1831568898
Provider Name (Legal Business Name): LUIS SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 250
MERIDEN CT
06450-0250
US

IV. Provider business mailing address

PO BOX 250
MERIDEN CT
06450-0250
US

V. Phone/Fax

Practice location:
  • Phone: 800-507-5040
  • Fax: 203-298-1051
Mailing address:
  • Phone: 800-507-5040
  • Fax: 203-298-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13748
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: