Provider Demographics
NPI:1578224382
Name:SANTALIZ, RAQUEL ESTHER (MED, BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ESTHER
Last Name:SANTALIZ
Suffix:
Gender:F
Credentials:MED, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 ECHO CIR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-4640
Mailing Address - Country:US
Mailing Address - Phone:610-905-1985
Mailing Address - Fax:
Practice Address - Street 1:961 MARCON BLVD STE 312
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9373
Practice Address - Country:US
Practice Address - Phone:610-266-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-55414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-21-55414OtherBOARD CERTIFIED BEHAVIOR ANALYST (BCBA)
PABH005173OtherLISCENSED BEHAVIOR SPECIALIST