Individual provider Active NPI

Milagros Santiago-Vazquez, PH.D.

  • Psychologist
  • Brentwood, NY
National Provider Identifier
1891062550
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
010085 Issued in NY
Practice address
77 Stahley Road
Loretta Park Elementary
Brentwood, NY 11717
Phone
(631) 434-2246
NPI assigned
Nov 23, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 010085 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X 010085-1 NY

Addresses

Primary practice location

77 Stahley Road
Loretta Park Elementary
Brentwood, NY 11717

Mailing address

77 Stahley Road
Loretta Park Elementary
Brentwood, NY 11717
Phone (631) 434-2246

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
010085NYMDOptician
010085-1NYMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1891062550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 STAHLEY ROAD",
            "address_2": "LORETTA PARK ELEMENTARY",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-434-2246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 STAHLEY ROAD",
            "address_2": "LORETTA PARK ELEMENTARY",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-434-2246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO-VAZQUEZ",
        "first_name": "MILAGROS",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-23",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "NY",
            "license": "010085",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "010085-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.