Healthcare Provider Details

I. General information

NPI: 1942755020
Provider Name (Legal Business Name): WILDELIA SANTIAGO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 LAKE WORTH RD
LAKE WORTH FL
33461-3231
US

IV. Provider business mailing address

URB. CARIOCA 1 CALLE 3 S
GUAYAMA PR
00784
US

V. Phone/Fax

Practice location:
  • Phone: 787-382-7220
  • Fax:
Mailing address:
  • Phone: 561-714-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21462
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4043
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: