Provider Demographics
NPI:1225366362
Name:CRUZ, CARMEN I (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:I
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 WASHINGTON GREEN
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6922
Mailing Address - Country:US
Mailing Address - Phone:845-863-3490
Mailing Address - Fax:
Practice Address - Street 1:20 GEORGE STREET,
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927
Practice Address - Country:US
Practice Address - Phone:845-942-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist