Healthcare Provider Details

I. General information

NPI: 1124445663
Provider Name (Legal Business Name): LA'SHONDRA MONIQUE DA CRUZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LA'SHONDRA MONIQUE CLARK MS

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 02/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 EDWARDS ST
NEW HAVEN CT
06511-3933
US

IV. Provider business mailing address

81 GILBERT AVE
HAMDEN CT
06514-3352
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-8648
  • Fax:
Mailing address:
  • Phone: 203-243-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: