Provider Demographics
NPI:1134496573
Name:SANTOS, TEYREM ILIEM (MA)
Entity Type:Individual
Prefix:
First Name:TEYREM
Middle Name:ILIEM
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6022
Mailing Address - Street 2:PMB 61
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-6022
Mailing Address - Country:US
Mailing Address - Phone:787-399-8093
Mailing Address - Fax:
Practice Address - Street 1:AVE. TENIENTE NELSON MARTINEZ
Practice Address - Street 2:CALLE 18 FF1 ARTURAS DE FLAMBOYAN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-399-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3408103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool