Provider Demographics
NPI:1457869703
Name:LEONARDO-CRUZ, JOEDY
Entity Type:Individual
Prefix:
First Name:JOEDY
Middle Name:
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 1:26 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7002
Mailing Address - Country:US
Mailing Address - Phone:978-590-8210
Mailing Address - Fax:
Practice Address - Street 1:26 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7002
Practice Address - Country:US
Practice Address - Phone:978-590-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist