Provider Demographics
NPI:1942073200
Name:PALMER CANCEL, SANTIAGO JOSE (PSYD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:JOSE
Last Name:PALMER CANCEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W THOMAS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4423
Mailing Address - Country:US
Mailing Address - Phone:602-406-3473
Mailing Address - Fax:
Practice Address - Street 1:222 W THOMAS RD STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4423
Practice Address - Country:US
Practice Address - Phone:602-406-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NM0121103TC0700X
AZPSY-005703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist