Healthcare Provider Details

I. General information

NPI: 1295862530
Provider Name (Legal Business Name): BILLY BENJAMIN SANTIAGO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 AVE PONCE DE LEON MIDTOWN BUILDING SUITE 701
SAN JUAN PR
00918-3416
US

IV. Provider business mailing address

1159 CALLE RAFAEL CASTILLO SAN AGUSTIN
SAN JUAN PR
00923-3228
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-5678
  • Fax:
Mailing address:
  • Phone: 939-940-8359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1932
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1932
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1932
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: