Healthcare Provider Details

I. General information

NPI: 1508715673
Provider Name (Legal Business Name): AMANDA R. SANTIAGO, LISW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 HILLVIEW CT NE
ALBUQUERQUE NM
87123-2126
US

IV. Provider business mailing address

PO BOX 50171
ALBUQUERQUE NM
87181-0171
US

V. Phone/Fax

Practice location:
  • Phone: 505-948-6405
  • Fax:
Mailing address:
  • Phone: 505-948-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA R SANTAIGO
Title or Position: OWNER
Credential: LCSW
Phone: 505-948-6405