Healthcare Provider Details

I. General information

NPI: 1477474542
Provider Name (Legal Business Name): RAVEN CRUZ LOAIZA MSW,LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BECKETT CENTER DR STE 125
WEST CHESTER OH
45069-5039
US

IV. Provider business mailing address

3784 BEULAH DR
SIDNEY OH
45365-9559
US

V. Phone/Fax

Practice location:
  • Phone: 513-520-2632
  • Fax: 937-913-4625
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608469
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: