Provider Demographics
NPI:1225600786
Name:CRUZ, FELICIA M (BSW)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:M
Last Name:CRUZ
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2606
Mailing Address - Country:US
Mailing Address - Phone:201-471-5696
Mailing Address - Fax:
Practice Address - Street 1:84 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7143
Practice Address - Country:US
Practice Address - Phone:201-487-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0183385Medicaid