Individual provider Active NPI

Maria Del Mar Feliciano Santiago, PSY D

  • Clinical Psychologist
  • Juana Diaz, PR
National Provider Identifier
1558947762
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6772 Issued in PR
Practice address
70 Calle Munoz Rivera
Juana Diaz, PR 00795-1635
Phone
(787) 901-1825
NPI assigned
Mar 19, 2021
Last updated
Mar 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6772 PR Primary

Addresses

Primary practice location

70 Calle Munoz Rivera
Juana Diaz, PR 00795-1635

Mailing address

PO Box 126
Penuelas, PR 00624-0126
Phone (787) 453-3332

Other identifiers 1

IdentifierTypeStateIssuer
6772OtherPRLICENCIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210730000518 PR Practitioner - Clinical Psychologist 1456754274 Practice locations: Juana Diaz, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Carlos R Vergne LLC PastSince Mar 1, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1558947762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "city": "PENUELAS",
            "state": "PR",
            "postal_code": "006240126",
            "telephone_number": "787-453-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 CALLE MUNOZ RIVERA",
            "city": "JUANA DIAZ",
            "state": "PR",
            "postal_code": "007951635",
            "telephone_number": "787-901-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELICIANO SANTIAGO",
        "first_name": "MARIA",
        "middle_name": "DEL MAR",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "6772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCIA",
            "identifier": "6772",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Juana Diaz, PR

Sources for this page

Verify at the official NPI Registry.