Healthcare Provider Details

I. General information

NPI: 1578146460
Provider Name (Legal Business Name): LORENA R VAZQUEZ SANTIAGO-GARCIA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VILLA ROSA I CALLE 6 A 17
GUAYAMA PR
00784
US

IV. Provider business mailing address

PO BOX 3415
GUAYAMA PR
00785-3415
US

V. Phone/Fax

Practice location:
  • Phone: 787-482-1372
  • Fax:
Mailing address:
  • Phone: 787-557-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92019
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1055
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24628
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27426
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1055
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6451
License Number StatePR
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6451
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: