Provider Demographics
NPI:1023807021
Name:SANTIAGO BOUSSON, ANA CAROLINA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:CAROLINA
Last Name:SANTIAGO BOUSSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 DENBIGH DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1530
Mailing Address - Country:US
Mailing Address - Phone:302-312-9620
Mailing Address - Fax:
Practice Address - Street 1:3618 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-5190
Practice Address - Country:US
Practice Address - Phone:302-725-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health