Provider Demographics
NPI:1093286213
Name:CRESPO CRUZ, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CRESPO CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BLVD DEL RIO APT 3102
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4506
Mailing Address - Country:US
Mailing Address - Phone:787-450-0881
Mailing Address - Fax:
Practice Address - Street 1:AA2 AVENIDA TEJAS PMB 132
Practice Address - Street 2:CORREO VILLA
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4349
Practice Address - Country:US
Practice Address - Phone:787-852-9331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6160103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling