Provider Demographics
NPI:1831662071
Name:CRUZ GONZALEZ, BRISA
Entity Type:Individual
Prefix:
First Name:BRISA
Middle Name:
Last Name:CRUZ GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRISA
Other - Middle Name:VERANIA
Other - Last Name:CRUZ GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:858 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:858 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2927
Practice Address - Country:US
Practice Address - Phone:718-859-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst