Provider Demographics
NPI:1679235824
Name:SANTIAGO CEDENO, REINA
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:SANTIAGO CEDENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 TWIN OAKS VLG
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1533
Mailing Address - Country:US
Mailing Address - Phone:413-212-1535
Mailing Address - Fax:
Practice Address - Street 1:93 TWIN OAKS VLG
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1533
Practice Address - Country:US
Practice Address - Phone:413-212-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-100858103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KIH337W09170OtherBLUE SHIELD