Healthcare Provider Details

I. General information

NPI: 1306339221
Provider Name (Legal Business Name): EDGAR DANIEL DE LA CRUZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 GRAND AVE STE 301C
OAKLAND CA
94610-4588
US

IV. Provider business mailing address

PO BOX 7041
RIVERSIDE CA
92513-7041
US

V. Phone/Fax

Practice location:
  • Phone: 510-221-6131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135626
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: