Provider Demographics
NPI:1639965650
Name:DE LA CRUZ FERREIRA, ISABEL
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:DE LA CRUZ FERREIRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WELSH ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5305
Mailing Address - Country:US
Mailing Address - Phone:617-959-5887
Mailing Address - Fax:
Practice Address - Street 1:42 WELSH ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5305
Practice Address - Country:US
Practice Address - Phone:617-959-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001333103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst