Provider Demographics
NPI:1174655419
Name:SANTIAGO, JESSENIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSENIA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 PASEO LAGO GARZAS
Mailing Address - Street 2:EXTENSION LAGO HORIZONTE CLL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2432
Mailing Address - Country:US
Mailing Address - Phone:787-479-2257
Mailing Address - Fax:787-845-4531
Practice Address - Street 1:CARR,153 KM 7.5
Practice Address - Street 2:BARRIO PASO SECO SECTOR USERAS
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-479-2257
Practice Address - Fax:787-845-4531
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical