Provider Demographics
NPI:1649679671
Name:CRUZ, MARISSA D (MA)
Entity type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:D
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MA
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 9742
Mailing Address - Street 2:PLAZA CAROLINA STATION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9742
Mailing Address - Country:US
Mailing Address - Phone:787-250-1912
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSIDAD INTERAMERICANA
Practice Address - Street 2:FRANCISCO SEIN
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00919
Practice Address - Country:UM
Practice Address - Phone:787-250-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4093103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool