Provider Demographics
NPI:1548592595
Name:SANTA, LAURAMAR (PSYD)
Entity type:Individual
Prefix:MRS
First Name:LAURAMAR
Middle Name:
Last Name:SANTA
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:COND. CONDADO PRINCESS WASHINGTON # 2
Mailing Address - Street 2:APT. 801
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-245-1129
Mailing Address - Fax:787-752-4644
Practice Address - Street 1:1826 FERNANDEZ JUNCOS AVE. STOP 26 1/2
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-726-8396
Practice Address - Fax:787-727-6672
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical