Provider Demographics
NPI:1871770800
Name:SANTIAGO, VIVIAN VANESSA (LCSW)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:VANESSA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREAT COVE LN
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4505
Mailing Address - Country:US
Mailing Address - Phone:516-485-5710
Mailing Address - Fax:516-485-4225
Practice Address - Street 1:175 FULTON AVE
Practice Address - Street 2:F.E.G.S. 3RD FLOOR
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3718
Practice Address - Country:US
Practice Address - Phone:516-485-5710
Practice Address - Fax:516-485-4225
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064342-1104100000X
NY080554-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker