Healthcare Provider Details

I. General information

NPI: 1700987351
Provider Name (Legal Business Name): CATHERINE CRUZ LICSW, LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAFAYETTE ST 103
PAWTUCKET RI
02860-6008
US

IV. Provider business mailing address

100 LAFAYETTE ST
PAWTUCKET RI
02860-6008
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-9916
  • Fax:
Mailing address:
  • Phone: 401-729-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00223
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00654
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: