MEDICARE: ANALICE CRUZ

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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700589157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANALICE CRUZ

Provider Business Mailing Address
First Line	:	1841 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-1316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2541 E 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3519
Country	:	US
Telephone Number	:	347-708-0777
Fax Number	:

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

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	09/13/2024

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Directions to “ ANALICE CRUZ ” Practice Location

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