Provider Demographics
NPI:1730651043
Name:DELACRUZ, JASMINE IVELISS I
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:IVELISS
Last Name:DELACRUZ
Suffix:I
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 1:377 WILDER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2458
Mailing Address - Country:US
Mailing Address - Phone:978-941-3033
Mailing Address - Fax:
Practice Address - Street 1:377 WILDER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2458
Practice Address - Country:US
Practice Address - Phone:978-941-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician