MEDICARE: CARRIE CRUZ BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-15-19773	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073947123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE CRUZ BCBA

Provider Business Mailing Address
First Line	:	550 CONGRESSIONAL BLVD STE 115
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-5644
Country	:	US
Telephone Number	:	317-249-2242
Fax Number	:

Provider Business Practice Location Address
First Line	:	8646 GUION RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3011
Country	:	US
Telephone Number	:	317-334-7331
Fax Number	:	317-334-7336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	10/09/2025

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