Provider Demographics
NPI:1174052781
Name:CRUZ SANCHEZ, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CRUZ SANCHEZ
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NH
Mailing Address - Zip Code:03752-0023
Mailing Address - Country:US
Mailing Address - Phone:802-526-4878
Mailing Address - Fax:802-357-5833
Practice Address - Street 1:449 LEAR HILL RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-7725
Practice Address - Country:US
Practice Address - Phone:802-526-4878
Practice Address - Fax:802-357-5833
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QS1000X
NH106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health