Basic Information
| Provider Information | |||||||||
| NPI: | 1780114454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ-DIEUDONNE | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | IRIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE GUSTAVE L LEVY PLACE | ||||||||
| Address2: | BOX 1126 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128441643 | ||||||||
| FaxNumber: | 2128445534 | ||||||||
| Practice Location | |||||||||
| Address1: | PO BOX 1126 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100290311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128441643 | ||||||||
| FaxNumber: | 2128445534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 099847-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.