Provider Demographics
NPI:1235570946
Name:SANTIAGO, BRENDA L (SW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:SW
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 9258
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9258
Mailing Address - Country:US
Mailing Address - Phone:787-690-2861
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLA CAROLINA CALLE 535
Practice Address - Street 2:BLOQ. 195 #4
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-690-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20555104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2660201OtherLICENCIA