Provider Demographics
NPI:1891936530
Name:SANTIAGO ANADON, MARIAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:SANTIAGO ANADON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 LA CAPITANA ST
Mailing Address - Street 2:URB PUNTO ORO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2002
Mailing Address - Country:US
Mailing Address - Phone:787-696-3114
Mailing Address - Fax:
Practice Address - Street 1:URB. INDUSTRIAL REPARADA 2
Practice Address - Street 2:396 DR. LUIS F. SALA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7004
Practice Address - Country:US
Practice Address - Phone:787-840-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3308103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist