Provider Demographics
NPI:1679668099
Name:BLOODWORTH-CRUZ, IDA (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:IDA
Middle Name:
Last Name:BLOODWORTH-CRUZ
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FAIRLAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522
Mailing Address - Country:US
Mailing Address - Phone:212-665-3993
Mailing Address - Fax:800-778-4468
Practice Address - Street 1:24 FAIRLAWN AVENUE
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522
Practice Address - Country:US
Practice Address - Phone:212-665-3993
Practice Address - Fax:800-778-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038188-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical