Provider Demographics
NPI:1831724665
Name:SANTIAGO FERNANDEZ, FLOR DE LIZ (LCSW, ASD SPECIALIST)
Entity type:Individual
Prefix:
First Name:FLOR DE LIZ
Middle Name:
Last Name:SANTIAGO FERNANDEZ
Suffix:
Gender:F
Credentials:LCSW, ASD SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 212TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3812
Mailing Address - Country:US
Mailing Address - Phone:786-263-3965
Mailing Address - Fax:
Practice Address - Street 1:8600 SW 212TH ST APT 210
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3812
Practice Address - Country:US
Practice Address - Phone:786-263-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR127751041C0700X
FLSW224911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical