Provider Demographics
NPI:1659630341
Name:SANTIAGO, CARLA V (MSW)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:V
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MSW
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 10007
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-4007
Mailing Address - Country:US
Mailing Address - Phone:787-458-6472
Mailing Address - Fax:
Practice Address - Street 1:URB. JARDINES DE LA REINA
Practice Address - Street 2:A- 5
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785-4007
Practice Address - Country:US
Practice Address - Phone:787-458-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical