Provider Demographics
NPI:1063302081
Name:CRUZ, KEITH ANTHONY JR (LPC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ANTHONY
Last Name:CRUZ
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W PROSPECT ST UNIT 214
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1652
Mailing Address - Country:US
Mailing Address - Phone:914-246-7821
Mailing Address - Fax:
Practice Address - Street 1:1000D LAKE ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1295
Practice Address - Country:US
Practice Address - Phone:201-639-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01044600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty