Provider Demographics
NPI:1104537190
Name:SANTIAGO RIVERA, YANELLIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:YANELLIE
Middle Name:
Last Name:SANTIAGO RIVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 2933
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-9481
Mailing Address - Country:US
Mailing Address - Phone:787-517-5430
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA PR- 719 KM 0.1
Practice Address - Street 2:BO. HELECHAL VIA LOS TORCHEROS
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-0079
Practice Address - Country:US
Practice Address - Phone:787-517-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical