Provider Demographics
NPI:1013226083
Name:SANTIAGO, EDWARD (PHD, MA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:
Credentials:PHD, MA
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 5103 P.M.B. 79
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-5103
Mailing Address - Country:US
Mailing Address - Phone:787-617-2373
Mailing Address - Fax:
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-1560
Practice Address - Country:US
Practice Address - Phone:787-617-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical