Healthcare Provider Details

I. General information

NPI: 1285565218
Provider Name (Legal Business Name): GIANNIE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CENTRE ST
BROCKTON MA
02302-3326
US

IV. Provider business mailing address

65 BYRON AVE
BROCKTON MA
02301-4201
US

V. Phone/Fax

Practice location:
  • Phone: 774-315-4929
  • Fax:
Mailing address:
  • Phone: 857-544-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: