Provider Demographics
NPI:1629839881
Name:D'SANTIAGO-EASTMAN, VERENICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VERENICE
Middle Name:
Last Name:D'SANTIAGO-EASTMAN
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 1:13745 IRON HORSE WAY
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3960
Mailing Address - Country:US
Mailing Address - Phone:210-535-1490
Mailing Address - Fax:
Practice Address - Street 1:16014 VIA SHAVANO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2364
Practice Address - Country:US
Practice Address - Phone:210-612-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70917103TS0200X
TX37627103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool