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General NPI Number Information
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NPI Number | 1023900669
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Entity Type | Individual
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Provider Name | NICOLETTE ROSE CRUZ PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 101 NICOLLS RD
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-689-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 27 NORWOOD LN
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City | RONKONKOMA
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State | NY
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Zip | 11779-3317
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Country | US
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Telephone | 631-559-7476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 756705
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License Number State | NY
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