Provider Demographics
NPI:1770464935
Name:DE LA CRUZ, OMAR LYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:LYN
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 CENTRAL ST UNIT 271
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1283
Mailing Address - Country:US
Mailing Address - Phone:310-498-9355
Mailing Address - Fax:
Practice Address - Street 1:2906 CENTRAL ST UNIT 271
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1283
Practice Address - Country:US
Practice Address - Phone:310-498-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty