MEDICARE: ELIZABETH CRUZ LCSW, RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	58983	TX

General Provider Information

NPI Number	:	1366214769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CRUZ LCSW, RPT

Provider Business Mailing Address
First Line	:	108 SUMMIT VW
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-3243
Country	:	US
Telephone Number	:	210-316-1026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3310
Country	:	US
Telephone Number	:	210-316-1026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/28/2023

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