Healthcare Provider Details

I. General information

NPI: 1801753710
Provider Name (Legal Business Name): EMILY GRACE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOUTH ST W STE 4F-1032
RAYNHAM MA
02767-5171
US

IV. Provider business mailing address

600 SOUTH ST W STE 4F-1032
RAYNHAM MA
02767-5171
US

V. Phone/Fax

Practice location:
  • Phone: 774-208-4363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number101106
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: