Provider Demographics
NPI:1740358431
Name:DELACRUZ, CARLOS (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N. COUNTRY CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201
Mailing Address - Country:US
Mailing Address - Phone:480-472-1454
Mailing Address - Fax:480-472-0592
Practice Address - Street 1:1025 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3307
Practice Address - Country:US
Practice Address - Phone:480-472-1454
Practice Address - Fax:480-472-0592
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist