Provider Demographics
NPI:1528181302
Name:CRUZ-MERCER, CARMEN M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:M
Last Name:CRUZ-MERCER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:M
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:637 WASHINGTON ST
Mailing Address - Street 2:CODMAN SQUARE HEALTH CNT
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124
Mailing Address - Country:US
Mailing Address - Phone:617-822-8242
Mailing Address - Fax:617-822-8148
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:CODMAN SQUARE HEALTH CNT
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124
Practice Address - Country:US
Practice Address - Phone:617-822-8242
Practice Address - Fax:617-822-8148
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10283561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical