Provider Demographics
NPI:1295862530
Name:SANTIAGO, BILLY BENJAMIN (PHD)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:BENJAMIN
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 CALLE RAFAEL CASTILLO
Mailing Address - Street 2:SAN AGUSTIN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3228
Mailing Address - Country:US
Mailing Address - Phone:939-940-8359
Mailing Address - Fax:
Practice Address - Street 1:420 AVE PONCE DE LEON
Practice Address - Street 2:MIDTOWN BUILDING SUITE 701
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3416
Practice Address - Country:US
Practice Address - Phone:787-765-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1932103TA0400X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent