Provider Demographics
NPI:1932636271
Name:DE LA CRUZ, ILUMINADA
Entity Type:Individual
Prefix:
First Name:ILUMINADA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILUMINADA
Other - Middle Name:
Other - Last Name:DE LA CRUZ MOREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:101Y00000X
Mailing Address - Street 1:2 MUSEUM SQ APT 412
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1536
Mailing Address - Country:US
Mailing Address - Phone:978-601-5314
Mailing Address - Fax:978-539-8542
Practice Address - Street 1:2 MUSEUM SQUARE APT 412
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-601-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor