Provider Demographics
NPI:1588335319
Name:SANTIAGO REYES, LETYANN (MS)
Entity type:Individual
Prefix:MISS
First Name:LETYANN
Middle Name:
Last Name:SANTIAGO REYES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CALLE MARCIAL BOSCH
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-5116
Mailing Address - Country:US
Mailing Address - Phone:787-205-3056
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE DE DIEGO 153 POSTERIOR
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-595-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6704103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty