Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003154873 |
---|---|
Provider Name | Mrs. Nicole Cruz |
First Address | Westampton, NJ 08060-3804 |
Second Address | Cherry Hill, NJ 08034-2053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2013 |
Last Update Date | 29/01/2013 |