Provider Demographics
NPI:1730632928
Name:CRUZ, ROSA A (LGPC)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3596
Mailing Address - Country:US
Mailing Address - Phone:240-304-3327
Mailing Address - Fax:410-609-7091
Practice Address - Street 1:7474 GREENWAY CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3596
Practice Address - Country:US
Practice Address - Phone:240-304-3327
Practice Address - Fax:410-609-7091
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional