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General NPI Number Information
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NPI Number | 1245512151
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Entity Type | Individual
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Provider Name | BERTHA LUCIA CRUZ PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 18 CENTRAL AVE
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City | PORT CHESTER
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State | NY
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Zip | 10573-5004
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Country | US
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Telephone | 914-934-8045
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Fax |
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Provider Business Mailing Address
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Address Line | 72 HARBOR DR
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City | STAMFORD
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State | CT
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Zip | 06902-7455
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Country | US
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Telephone | 203-550-6749
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Fax | 203-359-6559
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 015979
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002903
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License Number State | CT
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