Provider Demographics
NPI:1275749780
Name:WILFREDA J. CRUZ, LCSW-C, P.A.
Entity Type:Organization
Organization Name:WILFREDA J. CRUZ, LCSW-C, P.A.
Other - Org Name:FAMILY AND SENIOR OPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WILFREDA
Authorized Official - Middle Name:JENINE
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-741-1294
Mailing Address - Street 1:14502 CLOVER HILL TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4836
Mailing Address - Country:US
Mailing Address - Phone:410-741-1294
Mailing Address - Fax:410-741-1298
Practice Address - Street 1:14502 CLOVER HILL TER
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4836
Practice Address - Country:US
Practice Address - Phone:410-741-1294
Practice Address - Fax:410-741-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD549MMedicare ID - Type Unspecified