Provider Demographics
NPI:1790677847
Name:SANTIAGO, MARILYN (PSICOLOGA CLINICA)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PSICOLOGA CLINICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 CALLE AMBROSIO PADILLA
Mailing Address - Street 2:
Mailing Address - City:HATILLO, PR
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:939-301-2791
Mailing Address - Fax:
Practice Address - Street 1:BARRIO PUEBLO PARCELAS SANTA ROSA
Practice Address - Street 2:1951 CALLE AMBROSIO PADILLA
Practice Address - City:HATILLO, PR
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:939-301-2791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical