Provider Demographics
NPI:1134902760
Name:HARDING CRUZ, CHRISTINA ELAINE RENE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELAINE RENE
Last Name:HARDING CRUZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 CARSON LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2089
Mailing Address - Country:US
Mailing Address - Phone:239-246-0177
Mailing Address - Fax:
Practice Address - Street 1:3481 CARSON LAKES CIR
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2089
Practice Address - Country:US
Practice Address - Phone:239-246-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW209581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical