MEDICARE: MRS. VICTORIA J CRUZ HALL BA, MSW, LLMSW

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	6851118705	MI

General Provider Information

NPI Number	:	1659169647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA J CRUZ HALL BA, MSW, LLMSW

Provider Business Mailing Address
First Line	:	279 S JEFFERSON ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-2212
Country	:	US
Telephone Number	:	518-315-9743
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 DIVISION ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-1966
Country	:	US
Telephone Number	:	518-315-9743
Fax Number	:

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

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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