Provider Demographics
NPI:1144824525
Name:SANTIAGO MATOS, GINGER M (MSW)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:M
Last Name:SANTIAGO MATOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:M
Other - Last Name:SANTIAGO MATOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1097
Mailing Address - Country:US
Mailing Address - Phone:787-638-3282
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOS C. VZQUEZ
Practice Address - Street 2:BO. CAONILLAS
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1379
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:787-535-1114
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical