Provider Demographics
NPI:1023563251
Name:CRUZ, ALYSSA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 9TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2500
Mailing Address - Country:US
Mailing Address - Phone:510-665-9700
Mailing Address - Fax:510-665-9400
Practice Address - Street 1:2560 9TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2500
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:510-665-9400
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-22157103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst