Healthcare Provider Details

I. General information

NPI: 1356283451
Provider Name (Legal Business Name): AECHA MARIE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOPE ST
PROVIDENCE RI
02906-2001
US

IV. Provider business mailing address

55 HOPE ST
PROVIDENCE RI
02906-2001
US

V. Phone/Fax

Practice location:
  • Phone: 401-519-2300
  • Fax:
Mailing address:
  • Phone: 401-696-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04615
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: