Provider Demographics
NPI:1629468954
Name:CRUZ, ROBIN DENISE (LCAC, MSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:DENISE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LCAC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46225-1722
Mailing Address - Country:US
Mailing Address - Phone:317-379-7358
Mailing Address - Fax:
Practice Address - Street 1:5401 S EAST ST
Practice Address - Street 2:SUITE, 205-C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2064
Practice Address - Country:US
Practice Address - Phone:317-412-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000715A101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty