Provider Demographics
NPI:1346698719
Name:CRUZ, HAYDEN J (LMSW)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:J
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LONG ISLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798
Mailing Address - Country:US
Mailing Address - Phone:631-782-6200
Mailing Address - Fax:631-491-5354
Practice Address - Street 1:240 LONG ISLAND AVENUE
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798
Practice Address - Country:US
Practice Address - Phone:631-782-6200
Practice Address - Fax:631-491-5354
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72089046104100000X
NY0849891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker