Provider Demographics
NPI:1124595038
Name:CRUZ, ENRIQUE (LCSW,LICSW, PMHNP,RN)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LCSW,LICSW, PMHNP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 RICHARDSON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1932
Mailing Address - Country:US
Mailing Address - Phone:609-968-4193
Mailing Address - Fax:609-968-4193
Practice Address - Street 1:595 NEW LOUDON RD # 279
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4063
Practice Address - Country:US
Practice Address - Phone:774-231-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0935131041C0700X
MA1253061041C0700X
MARN23904442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical