Provider Demographics
NPI:1275239337
Name:DE LA CRUZ, DORI (LCSW)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 THRESHER ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1507
Mailing Address - Country:US
Mailing Address - Phone:815-621-3497
Mailing Address - Fax:
Practice Address - Street 1:432 THRESHER ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1507
Practice Address - Country:US
Practice Address - Phone:815-621-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0159101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical