Provider Demographics
NPI:1932925351
Name:SANTIAGO, LIAN MARIE (MSW)
Entity type:Individual
Prefix:
First Name:LIAN
Middle Name:MARIE
Last Name:SANTIAGO
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 1:12 CALLE POZO DEL VIENTO
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-9702
Mailing Address - Country:US
Mailing Address - Phone:939-250-3369
Mailing Address - Fax:
Practice Address - Street 1:CARR. NO.2 KM 8.2
Practice Address - Street 2:BO JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-7087
Practice Address - Country:US
Practice Address - Phone:939-250-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR155861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty