Provider Demographics
NPI:1629727094
Name:CRUZ, EILEEN MARIE
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
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 1:2020 KINGSLEY AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5181
Mailing Address - Country:US
Mailing Address - Phone:904-637-4910
Mailing Address - Fax:
Practice Address - Street 1:351 CROSSING BLVD APT 1321
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6231
Practice Address - Country:US
Practice Address - Phone:904-878-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)