Provider Demographics
NPI:1174869770
Name:CRUZ, ASHLEY EVETTE
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:EVETTE
Last Name:CRUZ
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 1:38 SARGENT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2135
Mailing Address - Country:US
Mailing Address - Phone:774-823-7548
Mailing Address - Fax:
Practice Address - Street 1:15 UNION ST STE 557
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1866
Practice Address - Country:US
Practice Address - Phone:978-682-7289
Practice Address - Fax:978-686-5954
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor