Provider Demographics
NPI:1649897265
Name:ROLON SANTIAGO, EMILY JUDITH
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:JUDITH
Last Name:ROLON SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS FUENTES DE COAMO
Mailing Address - Street 2:1234 CALLE SANTA ISABEL
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9318
Mailing Address - Country:US
Mailing Address - Phone:787-205-7784
Mailing Address - Fax:
Practice Address - Street 1:URB. LAS FUENTES DE COAMO
Practice Address - Street 2:1234 CALLE SANTA ISABEL
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-9318
Practice Address - Country:US
Practice Address - Phone:787-205-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist