Healthcare Provider Details

I. General information

NPI: 1851641054
Provider Name (Legal Business Name): LOURDES SANTIAGO-GELY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W MAGNOLIA ST
KISSIMMEE FL
34741-4117
US

IV. Provider business mailing address

200 HYGEIA DR STE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 800-457-4573
  • Fax: 800-443-6422
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002813
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: