Healthcare Provider Details

I. General information

NPI: 1912242512
Provider Name (Legal Business Name): JULIO SANTIAGO LCSW, CASAC-LV2
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

103 LOGAN ST FL 2
BROOKLYN NY
11208-1314
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-4000
  • Fax:
Mailing address:
  • Phone: 718-974-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: