Provider Demographics
NPI:1093097511
Name:SANTIAGO, JEZENIA (MSW)
Entity Type:Individual
Prefix:
First Name:JEZENIA
Middle Name:
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:HC-04 BOX 9077 BO. PALMA SOLA
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00729
Mailing Address - Country:UM
Mailing Address - Phone:787-633-8615
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 9077
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9869
Practice Address - Country:US
Practice Address - Phone:787-633-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR93231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical