Provider Demographics
NPI:1922768399
Name:SANTIAGO RODRIGUEZ, EDWIN D (MPSY)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:D
Last Name:SANTIAGO RODRIGUEZ
Suffix:
Gender:M
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. LOMA ALTA VILLAGE, APT. 3702
Mailing Address - Street 2:CAROLINA, P.R. 00987
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-378-4506
Mailing Address - Fax:
Practice Address - Street 1:431 AVE. HOSTOS
Practice Address - Street 2:SAN JUAN P.R. 00918
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7077103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling