Provider Demographics
NPI:1376987834
Name:MARISOL ACEVEDO CRUZ LLC
Entity Type:Organization
Organization Name:MARISOL ACEVEDO CRUZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-550-0179
Mailing Address - Street 1:100 WELLS ST. SUITE 2L
Mailing Address - Street 2:BUSHNELL ON THE PARK
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103
Mailing Address - Country:US
Mailing Address - Phone:860-550-0179
Mailing Address - Fax:
Practice Address - Street 1:100 WELLS ST. SUITE 2L
Practice Address - Street 2:BUSHNELL ON THE PARK
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103
Practice Address - Country:US
Practice Address - Phone:860-550-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1780887224OtherINDIVIDUAL NIP