Provider Demographics
NPI:1922507045
Name:DELACRUZ, NOELLE CHRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:CHRISTINE
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13505 TUFTS PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2948
Mailing Address - Country:US
Mailing Address - Phone:845-548-2932
Mailing Address - Fax:
Practice Address - Street 1:13505 TUFTS PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2948
Practice Address - Country:US
Practice Address - Phone:845-548-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1316103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool