Provider Demographics
NPI:1366865750
Name:CRUZ, PATRICIA RUTH (LCSW, DSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RUTH
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LCSW, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321383
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1383
Mailing Address - Country:US
Mailing Address - Phone:888-402-0840
Mailing Address - Fax:
Practice Address - Street 1:245 KATHERINE DR STE D
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9588
Practice Address - Country:US
Practice Address - Phone:803-260-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9351104100000X
MSC94231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker