Provider Demographics
NPI:1609277862
Name:CRUZ, AMY CAROLINE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CAROLINE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 COLLINS AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3518
Mailing Address - Country:US
Mailing Address - Phone:954-821-2618
Mailing Address - Fax:
Practice Address - Street 1:8900 COLLINS AVE APT 202
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-3518
Practice Address - Country:US
Practice Address - Phone:954-821-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health