Basic Information
| Provider Information | |||||||||
| NPI: | 1245484088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ-RESTO | ||||||||
| FirstName: | HERMINIA | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 896 ASYLUM AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605228241 | ||||||||
| FaxNumber: | 8605271919 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 ASYLUM AVE STE 502 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061052475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604228384 | ||||||||
| FaxNumber: | 8604228382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 001959 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.