Healthcare Provider Details

I. General information

NPI: 1255997409
Provider Name (Legal Business Name): ERIC CRUZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 MCKINLEY CT
NEW WINDSOR NY
12553-4930
US

IV. Provider business mailing address

2911 MCKINLEY CT
NEW WINDSOR NY
12553-4930
US

V. Phone/Fax

Practice location:
  • Phone: 845-204-8196
  • Fax:
Mailing address:
  • Phone: 845-204-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099723
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: