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General NPI Number Information
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NPI Number | 1104193267
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Entity Type | Individual
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Provider Name | LYDIA SANTIAGO LCSW-C, CAC-AD
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Gender | Female
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 9199 REISTERSTOWN RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4520
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Country | US
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Telephone | 443-743-9687
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Fax |
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Provider Business Mailing Address
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Address Line | 421 FALLSWAY
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City | BALTIMORE
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State | MD
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Zip | 21202-4800
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Country | US
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Telephone | 410-837-5533
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Fax | 410-837-2168
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AC0673
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23745
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License Number State | MD
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