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NPI Code Detail

MEDICARE: DIANA M SANTIAGO LCSW

MEDICARE: DIANA M SANTIAGO LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW15384FL

General Provider Information

NPI Number : 1417649146
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA M SANTIAGO LCSW
Provider Business Mailing Address
First Line : 7752 NW 124TH TER
Second Line :
City : PARKLAND
State : FL
Zip : 33076-4547
Country : US
Telephone Number : 954-232-5336
Fax Number :
Provider Business Practice Location Address
First Line : 6990 GRIFFIN RD
Second Line :
City : DAVIE
State : FL
Zip : 33314-4345
Country : US
Telephone Number : 754-248-9589
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2023
Last Update Date : 05/22/2023

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