Healthcare Provider Details

I. General information

NPI: 1275312621
Provider Name (Legal Business Name): RAUL A SANTIAGO COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 WORCESTER RD
FRAMINGHAM MA
01702-5255
US

IV. Provider business mailing address

466 COLUMBIA RD APT 1
DORCHESTER MA
02125-2337
US

V. Phone/Fax

Practice location:
  • Phone: 508-661-2020
  • Fax:
Mailing address:
  • Phone: 787-318-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2039
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: