Healthcare Provider Details

I. General information

NPI: 1114813573
Provider Name (Legal Business Name): JOSE IRIZARRY SANTIAGO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SANTIAGO IRIZARRY SANTIAGO LCSW

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 10/29/2026
Certification Date: 10/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W INDIANTOWN RD STE 106
JUPITER FL
33458-3539
US

IV. Provider business mailing address

3209 32ND WAY
WEST PALM BEACH FL
33407-6712
US

V. Phone/Fax

Practice location:
  • Phone: 561-222-3108
  • Fax:
Mailing address:
  • Phone: 786-960-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: