Healthcare Provider Details

I. General information

NPI: 1790888121
Provider Name (Legal Business Name): CESAR E CRUZ MSW, TACIII, PHD(C)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LAS MONJITAS 207 MONASTERIO ST
PONCE PR
00730-3907
US

IV. Provider business mailing address

URB LAS MONJITAS 207 MONASTERIO ST
PONCE PR
00730-3907
US

V. Phone/Fax

Practice location:
  • Phone: 787-202-8225
  • Fax:
Mailing address:
  • Phone: 787-202-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number05-20-6983
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8320
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: