Provider Demographics
NPI:1558037044
Name:DELACRUZ, DESIREE VICTORIA (LMHC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:VICTORIA
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6322
Mailing Address - Country:US
Mailing Address - Phone:516-998-5945
Mailing Address - Fax:
Practice Address - Street 1:121 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6322
Practice Address - Country:US
Practice Address - Phone:516-998-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health