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General NPI Number Information
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NPI Number | 1487296851
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Entity Type | Individual
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Provider Name | ROMEL POWELL SANTIAGO LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 1210 MILLENNIUM PKWY STE 1030
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City | BRANDON
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State | FL
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Zip | 33511-4858
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Country | US
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Telephone | 813-461-3098
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Fax | 813-475-4431
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Provider Business Mailing Address
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Address Line | PO BOX 263244
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City | TAMPA
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State | FL
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Zip | 33685-3244
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Country | US
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Telephone | 813-461-3098
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Fax | 813-475-4431
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW16753
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23565
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16753
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License Number State | FL
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