Provider Demographics
NPI:1780114454
Name:CRUZ-DIEUDONNE, NORMA IRIS
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:IRIS
Last Name:CRUZ-DIEUDONNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GUSTAVE L LEVY PLACE
Mailing Address - Street 2:BOX 1126
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-844-1643
Mailing Address - Fax:212-844-5534
Practice Address - Street 1:PO BOX 1126
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-0311
Practice Address - Country:US
Practice Address - Phone:212-844-1643
Practice Address - Fax:212-844-5534
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099847-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker