Healthcare Provider Details

I. General information

NPI: 1033031885
Provider Name (Legal Business Name): MARIELY SANTIAGO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 CALLE FERNANDO L GARCIA
UTUADO PR
00641-3068
US

IV. Provider business mailing address

706 SECT HEREDIA
UTUADO PR
00641-3041
US

V. Phone/Fax

Practice location:
  • Phone: 787-908-8568
  • Fax:
Mailing address:
  • Phone: 787-908-8568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8905
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: