Provider Demographics
NPI:1184959256
Name:CRUZ, GUSTAVO (LCSW)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7732
Mailing Address - Country:US
Mailing Address - Phone:956-279-1504
Mailing Address - Fax:
Practice Address - Street 1:341 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6117
Practice Address - Country:US
Practice Address - Phone:956-802-1170
Practice Address - Fax:956-318-0137
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15042104100000X, 251B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management