Provider Demographics
NPI:1467666586
Name:SANTIAGO, MARISOL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEOS LOS ROBLES,
Mailing Address - Street 2:EPIFANIO VIDAL 1526
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-832-2117
Mailing Address - Fax:
Practice Address - Street 1:RAMAL 111
Practice Address - Street 2:INRTERCESION 480
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-891-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical