Provider Demographics
NPI:1619289402
Name:SANTIAGO, LISANDRA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:LISANDRA
Middle Name:
Last Name: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 1:114 CALLE NIVAL
Mailing Address - Street 2:HACIENDA PALOMA
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-3046
Mailing Address - Country:US
Mailing Address - Phone:787-235-1467
Mailing Address - Fax:
Practice Address - Street 1:114 CALLE NIVAL
Practice Address - Street 2:HACIENDA PALOMA
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-3047
Practice Address - Country:US
Practice Address - Phone:787-235-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical