Provider Demographics
NPI:1013508308
Name:LEONARDO-CRUZ, JEIDY FERNANDO
Entity Type:Individual
Prefix:
First Name:JEIDY
Middle Name:FERNANDO
Last Name:LEONARDO-CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ROBBS HILL RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-2167
Mailing Address - Country:US
Mailing Address - Phone:774-270-1766
Mailing Address - Fax:
Practice Address - Street 1:211 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841
Practice Address - Country:US
Practice Address - Phone:978-701-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician