Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 8229 | MA |
NPI | 1003017815 |
---|---|
Provider Name | Mr. Jaime Santiago |
First Address | Chicopee, MA 01013-2870 |
Second Address | Chicopee, MA 01013-2870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 09/10/2019 |