Provider Demographics
NPI:1013647379
Name:SANTIAGO FELICIANO, LIZVETTE (MSW)
Entity Type:Individual
Prefix:MISS
First Name:LIZVETTE
Middle Name:
Last Name:SANTIAGO FELICIANO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:LIZVETTE
Other - Middle Name:
Other - Last Name:SANTIAGO FELICIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 4799
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-9681
Mailing Address - Country:US
Mailing Address - Phone:787-243-8481
Mailing Address - Fax:
Practice Address - Street 1:BARRIO SANTO DOMINGO 2 PARCELA #30
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-9681
Practice Address - Country:US
Practice Address - Phone:787-243-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR157131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical