Healthcare Provider Details

I. General information

NPI: 1922477876
Provider Name (Legal Business Name): ZULEYKA ENID SANTIAGO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 SUMMERWALK SQ APT A
WINTER PARK FL
32792-6769
US

IV. Provider business mailing address

4417 SUMMERWALK SQ APT A
WINTER PARK FL
32792-6769
US

V. Phone/Fax

Practice location:
  • Phone: 787-944-1771
  • Fax: 787-944-1771
Mailing address:
  • Phone: 787-944-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13112
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: