Healthcare Provider Details

I. General information

NPI: 1962723866
Provider Name (Legal Business Name): MICHELLE LIZZETTE CRUZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 BLOOMFIELD DR APT. 211
ORLANDO FL
32825-5903
US

IV. Provider business mailing address

10600 BLOOMFIELD DR APT. 211
ORLANDO FL
32825-5903
US

V. Phone/Fax

Practice location:
  • Phone: 305-772-7324
  • Fax: 407-862-2737
Mailing address:
  • Phone: 305-772-7324
  • Fax: 407-862-2737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: