Healthcare Provider Details

I. General information

NPI: 1689966988
Provider Name (Legal Business Name): EMILY LORRAINE MALAVET-SANTIAGO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 ATRIUM DR
ORLANDO FL
32822-3744
US

IV. Provider business mailing address

3625 ATRIUM DR
ORLANDO FL
32822-3744
US

V. Phone/Fax

Practice location:
  • Phone: 787-601-5604
  • Fax: 787-837-4742
Mailing address:
  • Phone: 787-601-5604
  • Fax: 787-837-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3902
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY12015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: