Provider Demographics
NPI:1124595038
Name:CRUZ, ENRIQUE (LCSW,LICSW, PMHNP,RN)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LCSW,LICSW, PMHNP,RN
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 24520
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:609-968-4193
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-4063
Practice Address - Country:US
Practice Address - Phone:781-744-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0935131041C0700X
MA1253061041C0700X
MARN23904442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical