MEDICARE: CATHERINE CRUZ LICSW, LCDP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	00223	RI
2	1041C0700X	Clinical Social Worker	ISW00654	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26463-3	OTHER	RI	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1700987351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE CRUZ LICSW, LCDP

Provider Business Mailing Address
First Line	:	100 LAFAYETTE ST
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-6008
Country	:	US
Telephone Number	:	401-729-9916
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 LAFAYETTE ST
Second Line	:	103
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-6008
Country	:	US
Telephone Number	:	401-729-9916
Fax Number	:

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/11/2025

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