Provider Demographics
NPI:1801015383
Name:CRUZ, ANGELICA CRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:CRISTINA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TARMAN DR
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-3932
Mailing Address - Country:US
Mailing Address - Phone:707-894-4229
Mailing Address - Fax:707-894-2954
Practice Address - Street 1:406 W STANDLEY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4348
Practice Address - Country:US
Practice Address - Phone:707-621-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264561041C0700X
CALCSW26456104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical