MEDICARE: MAILYN CRUZ CBHCMS

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	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator
3	104100000X	Social Worker	CBHCMS100013	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639524515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAILYN CRUZ CBHCMS

Provider Business Mailing Address
First Line	:	2500 E HALLANDALE BEACH BLVD STE 802
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4841
Country	:	US
Telephone Number	:	786-322-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 E HALLANDALE BEACH BLVD STE 802
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4841
Country	:	US
Telephone Number	:	786-322-0862
Fax Number	:

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

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	05/04/2023

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