Healthcare Provider Details

I. General information

NPI: 1336631027
Provider Name (Legal Business Name): DEMELIZ ALOMAR-SANTIAGO M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 5TH ST
SAINT CLOUD FL
34769-2024
US

IV. Provider business mailing address

1900 CELEBRATION BLVD APT 303
CELEBRATION FL
34747-4954
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-0068
  • Fax:
Mailing address:
  • Phone: 787-929-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11544
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: