Provider Demographics
NPI:1710060108
Name:DE LA CRUZ, SONIA MARIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:MARIA
Last Name:DE LA 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 1:6120 GRAND CENTRAL PKWY
Mailing Address - Street 2:APT B 507
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1263
Mailing Address - Country:US
Mailing Address - Phone:917-673-7581
Mailing Address - Fax:
Practice Address - Street 1:6120 GRAND CENTRAL PKWY
Practice Address - Street 2:APT.B-507
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1263
Practice Address - Country:US
Practice Address - Phone:917-673-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003604-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health