Provider Demographics
NPI:1114813573
Name:IRIZARRY SANTIAGO, JOSE ALBERTO (RCSWI)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALBERTO
Last Name:IRIZARRY SANTIAGO
Suffix:
Gender:M
Credentials:RCSWI
Other - Prefix:MR
Other - First Name:SANTIAGO
Other - Middle Name:ALBERTO
Other - Last Name:IRIZARRY SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCSWI
Mailing Address - Street 1:1648 LINDLEY ST
Mailing Address - Street 2:
Mailing Address - City:MANGONIA PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2123
Mailing Address - Country:US
Mailing Address - Phone:786-960-4771
Mailing Address - Fax:
Practice Address - Street 1:1648 LINDLEY ST
Practice Address - Street 2:
Practice Address - City:MANGONIA PARK
Practice Address - State:FL
Practice Address - Zip Code:33407-2123
Practice Address - Country:US
Practice Address - Phone:786-960-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW193941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical