Provider Demographics
NPI:1154430478
Name:SANTIAGO, MARIA VIRGEN (PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VIRGEN
Last Name:SANTIAGO
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:BO. RABANAL
Mailing Address - Street 2:RR-01 BUZON 2407
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-2407
Mailing Address - Country:US
Mailing Address - Phone:787-263-8470
Mailing Address - Fax:787-739-8190
Practice Address - Street 1:AVE EL JIBARO CARR 172 KM 13.5 BO BAYAMON
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:787-739-8190
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2695103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling