MEDICARE: HERMINIA CRUZ-RESTO MSW, LCSW

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	1041C0700X	Clinical Social Worker	001959	CT

General Provider Information

NPI Number	:	1245484088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMINIA CRUZ-RESTO MSW, LCSW

Provider Business Mailing Address
First Line	:	896 ASYLUM AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105
Country	:	US
Telephone Number	:	860-522-8241
Fax Number	:	860-527-1919

Provider Business Practice Location Address
First Line	:	999 ASYLUM AVE STE 502
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-2475
Country	:	US
Telephone Number	:	860-422-8384
Fax Number	:	860-422-8382

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

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	07/21/2022

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