Provider Demographics
NPI:1871164129
Name:ALVAREZ SANTIAGO, KENDRA (LPSYC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ALVAREZ SANTIAGO
Suffix:
Gender:F
Credentials:LPSYC
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:ALVAREZ- SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPSYC
Mailing Address - Street 1:BAYAMON CTR
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6927
Mailing Address - Country:US
Mailing Address - Phone:787-604-2141
Mailing Address - Fax:787-639-7977
Practice Address - Street 1:C/REVERENDO DOMINGO MARRERO NAVARRO B
Practice Address - Street 2:CALLE REVERENDO DOMINGO MARRERO NAVARRO B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-639-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25219104100000X
PR6955103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty