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NPI Code Detail

MEDICARE: JESSSICA SANTIAGO BCBA, LABA

MEDICARE: JESSSICA SANTIAGO BCBA, LABA
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
1103K00000XBehavior Analyst3103-MH-B1MA

General Provider Information

NPI Number : 1780359364
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSSICA SANTIAGO BCBA, LABA
Provider Business Mailing Address
First Line : 5 STRATFORD RD
Second Line :
City : CANTON
State : MA
Zip : 02021-4213
Country : US
Telephone Number : 781-366-4210
Fax Number :
Provider Business Practice Location Address
First Line : 5 STRATFORD RD
Second Line :
City : CANTON
State : MA
Zip : 02021-4213
Country : US
Telephone Number : 508-596-6222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2021
Last Update Date : 08/15/2021

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