Provider Demographics
NPI:1235553686
Name:SANTIAGO PADIN, MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:SANTIAGO PADIN
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 1:222 W GREGORY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1127
Mailing Address - Country:US
Mailing Address - Phone:816-361-0064
Mailing Address - Fax:
Practice Address - Street 1:222 W GREGORY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1127
Practice Address - Country:US
Practice Address - Phone:816-361-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014001576103T00000X
KS1858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist