=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356480073
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOLANDA CRUZ-MARTINEZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 E POST RD FL 2
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-5113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-995-6074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 DAVENPORT AVE APT 2H
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10805-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-995-5233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R026026-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------