Provider Demographics
NPI:1356844799
Name:CRUZ-ORTIZ, NIDIA J (LCSW)
Entity Type:Individual
Prefix:
First Name:NIDIA
Middle Name:J
Last Name:CRUZ-ORTIZ
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 1:3614 SW 129TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-3868
Mailing Address - Country:US
Mailing Address - Phone:352-220-2375
Mailing Address - Fax:
Practice Address - Street 1:2553 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7009
Practice Address - Country:US
Practice Address - Phone:352-732-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW16029104100000X
IL149.0196301041C0700X
FLSW175491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker