Provider Demographics
NPI:1053928135
Name:SANTELICES, BARBARA Y
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:Y
Last Name:SANTELICES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 N HIGHLAND AVE APT M168
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2132
Mailing Address - Country:US
Mailing Address - Phone:727-313-7964
Mailing Address - Fax:
Practice Address - Street 1:1799 N HIGHLAND AVE APT M168
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2132
Practice Address - Country:US
Practice Address - Phone:727-313-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician