Provider Demographics
NPI:1295298974
Name:SANTANA, KETCIA LIMARY (MSW)
Entity type:Individual
Prefix:MS
First Name:KETCIA
Middle Name:LIMARY
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 20 #579
Mailing Address - Street 2:URB VERDE MAR
Mailing Address - City:PUNTA SANTIAGO
Mailing Address - State:PR
Mailing Address - Zip Code:00741
Mailing Address - Country:US
Mailing Address - Phone:787-221-1934
Mailing Address - Fax:
Practice Address - Street 1:128 CALLE FONT MARTELO
Practice Address - Street 2:ESQUINA RAMON GOMEZ
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR144761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical