Provider Demographics
NPI:1457775884
Name:SANTIAGO, EVELYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
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:HC 4 BOX 45322
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9640
Mailing Address - Country:US
Mailing Address - Phone:787-612-4833
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 45322
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9640
Practice Address - Country:US
Practice Address - Phone:787-612-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical