Provider Demographics
NPI:1225911399
Name:DESANTIAGO, BENITA VANESSA
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:VANESSA
Last Name:DESANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2001
Mailing Address - Country:US
Mailing Address - Phone:262-337-2292
Mailing Address - Fax:
Practice Address - Street 1:815 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2001
Practice Address - Country:US
Practice Address - Phone:262-337-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician