Healthcare Provider Details

I. General information

NPI: 1255162889
Provider Name (Legal Business Name): NEAL SANTACRUZ LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 GREENPOINT AVE APT 2C
SUNNYSIDE NY
11104-1786
US

IV. Provider business mailing address

4601 GREENPOINT AVE APT 2C
SUNNYSIDE NY
11104-1786
US

V. Phone/Fax

Practice location:
  • Phone: 917-957-6958
  • Fax:
Mailing address:
  • Phone: 917-957-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NEAL SANTACRUZ
Title or Position: OWNER
Credential: LCSW
Phone: 917-957-6958