Healthcare Provider Details

I. General information

NPI: 1710502059
Provider Name (Legal Business Name): ARIEL MANOLO DE LA CRUZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 N LITTLE TOR RD
NEW CITY NY
10956-2627
US

IV. Provider business mailing address

2570 ROUTE 9W STE 10
CORNWALL NY
12518-1370
US

V. Phone/Fax

Practice location:
  • Phone: 845-999-3060
  • Fax:
Mailing address:
  • Phone: 845-220-3100
  • Fax: 845-534-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number108358-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: