Healthcare Provider Details

I. General information

NPI: 1609795657
Provider Name (Legal Business Name): MIA ALEXANDRA MATEO CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 TAYLOR ST APT C212
SPRINGFIELD MA
01103-1246
US

IV. Provider business mailing address

24 TAYLOR ST APT C212
SPRINGFIELD MA
01103-1246
US

V. Phone/Fax

Practice location:
  • Phone: 787-664-9619
  • Fax:
Mailing address:
  • Phone: 787-664-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number7976
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: