Healthcare Provider Details

I. General information

NPI: 1235860065
Provider Name (Legal Business Name): ELENA ANDREA CRUZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PLEASANT ST
WORCESTER MA
01609-1821
US

IV. Provider business mailing address

505 PLEASANT ST
WORCESTER MA
01609-1821
US

V. Phone/Fax

Practice location:
  • Phone: 508-796-0177
  • Fax: 508-753-9779
Mailing address:
  • Phone: 508-414-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number225430
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: