Provider Demographics
NPI:1487380614
Name:CRUZE, RACHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:CRUZE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2283
Mailing Address - Country:US
Mailing Address - Phone:817-789-2439
Mailing Address - Fax:
Practice Address - Street 1:4826 EDISON AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2283
Practice Address - Country:US
Practice Address - Phone:817-789-2439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099284121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical