Healthcare Provider Details

I. General information

NPI: 1881911469
Provider Name (Legal Business Name): DENNIS DE LA CRUZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 5TH AVE
NEW YORK NY
10029-3119
US

IV. Provider business mailing address

1301 5TH AVENUE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax: 212-410-7561
Mailing address:
  • Phone: 212-426-3400
  • Fax: 212-410-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number075509-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: