Basic Information
| Provider Information | |||||||||
| NPI: | 1568763712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 553 58TH ST | ||||||||
| Address2: | AOARTMENT21 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112203842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473357759 | ||||||||
| FaxNumber: | 8452550236 | ||||||||
| Practice Location | |||||||||
| Address1: | 553 58TH ST | ||||||||
| Address2: | 2I | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112203842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473357759 | ||||||||
| FaxNumber: | 7182933980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2010 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 017450 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.