Provider Demographics
NPI:1063047991
Name:SANTIAGO MIRANDA, FELIX ANGEL (MSW, LSW)
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:ANGEL
Last Name:SANTIAGO MIRANDA
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VISTA BELLA D2 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:939-242-8701
Mailing Address - Fax:
Practice Address - Street 1:URB. VISTA BELLA D2 CALLE 5
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-0076
Practice Address - Country:US
Practice Address - Phone:939-242-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009922283104100000X
PR143201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty