Provider Demographics
NPI:1033601158
Name:CRUZ, JULIE M (BCBA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:CRUZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2216 MANDRELL CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-2750
Mailing Address - Country:US
Mailing Address - Phone:850-768-4664
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:1909 HILLBROOKE TRL STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7902
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-695-9100
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-67409103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst