Provider Demographics
NPI:1770464026
Name:SANTIAGO GONZALEZ, JAYNI NICOLE (MA)
Entity type:Individual
Prefix:
First Name:JAYNI
Middle Name:NICOLE
Last Name:SANTIAGO GONZALEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CALLE AMATISTA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1904
Mailing Address - Country:US
Mailing Address - Phone:787-562-3772
Mailing Address - Fax:787-562-3772
Practice Address - Street 1:CALLE PADRE RIVERA 15 OESTE
Practice Address - Street 2:SEGUNDO PISO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3691
Practice Address - Country:US
Practice Address - Phone:787-529-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8571103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling