Provider Demographics
NPI:1558947762
Name:FELICIANO SANTIAGO, MARIA DEL MAR (PSY D)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL MAR
Last Name:FELICIANO SANTIAGO
Suffix:
Gender:F
Credentials:PSY D
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 126
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0126
Mailing Address - Country:US
Mailing Address - Phone:787-453-3332
Mailing Address - Fax:
Practice Address - Street 1:70 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1635
Practice Address - Country:US
Practice Address - Phone:787-901-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6772OtherLICENCIA