Provider Demographics
NPI:1295466878
Name:SANTIAGO MONTALVO, AMY (LCDA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SANTIAGO MONTALVO
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION VILLAS DEL CAFETAL
Mailing Address - Street 2:CALLE 7 G25
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-955-2214
Mailing Address - Fax:
Practice Address - Street 1:PLAZA DEL MERCADO GUAYANILLA, PR-127
Practice Address - Street 2:OFICINA #7
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656
Practice Address - Country:US
Practice Address - Phone:787-955-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006910103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling