Provider Demographics
NPI:1821492430
Name:CRUZ, HERIBERTO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HERIBERTO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2463
Mailing Address - Country:US
Mailing Address - Phone:786-239-3006
Mailing Address - Fax:
Practice Address - Street 1:426 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2463
Practice Address - Country:US
Practice Address - Phone:786-239-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical