Provider Demographics
NPI:1265107940
Name:CRUZ, NILDA JUDITH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:NILDA
Middle Name:JUDITH
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34008
Mailing Address - Street 2:
Mailing Address - City:FORT BUCHANAN
Mailing Address - State:PR
Mailing Address - Zip Code:00934-0008
Mailing Address - Country:US
Mailing Address - Phone:787-240-0689
Mailing Address - Fax:
Practice Address - Street 1:M70 AVE SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4800
Practice Address - Country:US
Practice Address - Phone:787-240-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional