Provider Demographics
NPI:1104649011
Name:EAST NEW DAWN PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:EAST NEW DAWN PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.PSY
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ MORALES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-857-4720
Mailing Address - Street 1:URB. VERDE MAR
Mailing Address - Street 2:991 CALLE ZIRCONIA
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00741-2125
Mailing Address - Country:US
Mailing Address - Phone:787-857-4720
Mailing Address - Fax:787-561-7464
Practice Address - Street 1:126 CALLE CRUZ ORTIZ STELLA S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3727
Practice Address - Country:US
Practice Address - Phone:787-850-4720
Practice Address - Fax:787-561-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty