Provider Demographics
NPI:1083410112
Name:SANTIAGO, LLELIDZA BRUNILDA (MSW)
Entity type:Individual
Prefix:
First Name:LLELIDZA
Middle Name:BRUNILDA
Last Name:SANTIAGO
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2446
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4446
Mailing Address - Country:US
Mailing Address - Phone:787-381-5794
Mailing Address - Fax:
Practice Address - Street 1:MANSIONES EN PASEO DE LOS REYES
Practice Address - Street 2:CALLE REINA ALEXANDRA 49
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-381-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR141721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical