Provider Demographics
NPI:1124594247
Name:CRUZ, ALICIA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 SILVER LN STE 4
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1027
Mailing Address - Country:US
Mailing Address - Phone:860-808-9018
Mailing Address - Fax:
Practice Address - Street 1:367 SILVER LN STE 4
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1027
Practice Address - Country:US
Practice Address - Phone:860-808-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist