Healthcare Provider Details

I. General information

NPI: 1144762279
Provider Name (Legal Business Name): ALYSSA KATI CRUZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MICHIGAN AVE STE 1430
CHICAGO IL
60601-7653
US

IV. Provider business mailing address

6051 N FRESNO ST STE 201
FRESNO CA
93710-5280
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-6780
  • Fax:
Mailing address:
  • Phone: 559-248-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: