Healthcare Provider Details

I. General information

NPI: 1992669063
Provider Name (Legal Business Name): CRUZ BEHAVIORAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 BUCKEYE FALLS WAY
ORLANDO FL
32824-4347
US

IV. Provider business mailing address

1687 BUCKEYE FALLS WAY
ORLANDO FL
32824-4347
US

V. Phone/Fax

Practice location:
  • Phone: 407-837-3039
  • Fax: 689-223-7310
Mailing address:
  • Phone: 407-837-3039
  • Fax: 689-223-7310

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 Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE M. CRUZ CARLO
Title or Position: OWNER
Credential:
Phone: 407-445-8915