Provider Demographics
NPI:1811010275
Name:CRUZ, CRISTINA FILOMENA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:FILOMENA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CONSELYEA ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2202
Mailing Address - Country:US
Mailing Address - Phone:646-773-2263
Mailing Address - Fax:
Practice Address - Street 1:14 CONSELYEA ST
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2202
Practice Address - Country:US
Practice Address - Phone:646-773-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7442235Z00000X
NY016736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist