Provider Demographics
NPI:1104548684
Name:SANTIAGO LABOY, IVONNE MARIE (MSW)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARIE
Last Name:SANTIAGO LABOY
Suffix:
Gender:F
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 485
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0485
Mailing Address - Country:US
Mailing Address - Phone:787-981-0528
Mailing Address - Fax:
Practice Address - Street 1:CARR. 181 M 34 BO MARIN SECTOR LA LINEA
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-839-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15917104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker