Provider Demographics
NPI:1558873331
Name:ROSARIO SANTIAGO, BRENDA LIZ (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LIZ
Last Name:ROSARIO 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 1:5454 LEIGHTON LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5222
Mailing Address - Country:US
Mailing Address - Phone:787-637-9158
Mailing Address - Fax:
Practice Address - Street 1:5454 LEIGHTON LN
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5222
Practice Address - Country:US
Practice Address - Phone:787-637-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist