Provider Demographics
NPI:1427944701
Name:CRUZ, KEVIN (MSED)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CEDAR AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5521
Mailing Address - Country:US
Mailing Address - Phone:917-374-2112
Mailing Address - Fax:
Practice Address - Street 1:2200 CEDAR AVE APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5521
Practice Address - Country:US
Practice Address - Phone:917-374-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1909102251103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst