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General NPI Number Information
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NPI Number | 1275749780
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Entity Type | Organization
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Legal Business Name | WILFREDA J. CRUZ, LCSW-C, P.A.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14502 CLOVER HILL TER
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City | BOWIE
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State | MD
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Zip | 20720-4836
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Country | US
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Telephone | 410-741-1294
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Fax | 410-741-1298
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Provider Business Mailing Address
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Address Line | 14502 CLOVER HILL TER
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City | BOWIE
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State | MD
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Zip | 20720-4836
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Country | US
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Telephone | 410-741-1294
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Fax | 410-741-1298
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Authorized Official
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Title or Position | CLINICAL DIRECTOR PRESIDENT
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Name | MS. WILFREDA JENINE CRUZ
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Credential | LCSW-C
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Telephone | 410-741-1294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11330
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License Number State | MD
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