Healthcare Provider Details

I. General information

NPI: 1013841980
Provider Name (Legal Business Name): DOMINIQUE MILAGROS CRUZ-SOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOMINIQUE MILAGROS CRUZ

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 FLORENCE RD
FLORENCE MA
01062-2621
US

IV. Provider business mailing address

226 FLORENCE RD
FLORENCE MA
01062-2621
US

V. Phone/Fax

Practice location:
  • Phone: 413-222-2360
  • Fax:
Mailing address:
  • Phone: 413-222-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW230049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: