Active NPI
Marisol Camacho Santiago, PSY.D
- Clinical Psychologist
- Ponce, PR
National Provider Identifier
1417238353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 002163
- Practice address
- 367 Calle Picaflor
Urb. Camino del Sur
Ponce, PR 00716-2814 - Phone
- (787) 309-4749
- Fax
- (787) 840-2317
- NPI assigned
- Sep 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 002163 | PR | Primary |
Addresses
Primary practice location
367 Calle Picaflor
Urb. Camino del Sur
Ponce, PR 00716-2814
Mailing address
Urb. Camino del Sur 367 Calle Picaflor
Ponce, PR 00731-2814
Phone (787) 309-4749
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002163 | PR | MD | Clinical Psychologist |
| 2163 | PR | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315267200000",
"number": "1417238353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "URB. CAMINO DEL SUR 367 CALLE PICAFLOR",
"city": "PONCE",
"state": "PR",
"postal_code": "007312814",
"telephone_number": "787-309-4749",
"fax_number": "787-840-2317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "367 CALLE PICAFLOR",
"address_2": "URB. CAMINO DEL SUR",
"city": "PONCE",
"state": "PR",
"postal_code": "007162814",
"telephone_number": "787-309-4749",
"fax_number": "787-840-2317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMACHO SANTIAGO",
"first_name": "MARISOL",
"name_prefix": "Mrs.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-06",
"last_updated": "2011-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "002163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponce, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.