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General NPI Number Information
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NPI Number | 1174052781
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Entity Type | Individual
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Provider Name | JACQUELINE CRUZ SANCHEZ
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Gender | Female
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 449 LEAR HILL RD
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City | NEWPORT
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State | NH
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Zip | 03773-7725
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Country | US
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Telephone | 802-526-4878
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Fax | 802-357-5833
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | GOSHEN
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State | NH
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Zip | 03752-0023
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Country | US
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Telephone | 802-526-4878
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Fax | 802-357-5833
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | NH
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