Provider Demographics
NPI:1669996849
Name:CRUZ, MARISSA K (MS)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:K
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 BETHLEHEM FIELDS WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-9539
Mailing Address - Country:US
Mailing Address - Phone:610-216-0269
Mailing Address - Fax:
Practice Address - Street 1:628 TWIN PONDS RD
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1843
Practice Address - Country:US
Practice Address - Phone:610-216-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003350103K00000X
PAPC010418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst