Provider Demographics
NPI:1720770506
Name:CABRERO SANTIAGO, EMILY NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:NICOLE
Last Name:CABRERO SANTIAGO
Suffix:
Gender:F
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:HC 2 BOX 3603
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-9752
Mailing Address - Country:US
Mailing Address - Phone:787-204-0299
Mailing Address - Fax:
Practice Address - Street 1:2351 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0776
Practice Address - Country:US
Practice Address - Phone:787-290-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical