Provider Demographics
NPI:1477443398
Name:CRUZ SOTOMAYOR, WALESKA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:WALESKA
Middle Name:
Last Name:CRUZ SOTOMAYOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 POPLAR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7636
Mailing Address - Country:US
Mailing Address - Phone:410-440-1734
Mailing Address - Fax:
Practice Address - Street 1:5025 POPLAR RIDGE LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-7636
Practice Address - Country:US
Practice Address - Phone:410-440-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12300101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health