Healthcare Provider Details

I. General information

NPI: 1629631833
Provider Name (Legal Business Name): LORRAINE CRUZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 LATHAM ST
RIVERSIDE CA
92501-1706
US

IV. Provider business mailing address

5005 LA MART DR STE 106
RIVERSIDE CA
92507-5991
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax: 360-462-2757
Mailing address:
  • Phone: 951-602-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127681
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: