Provider Demographics
NPI:1780887224
Name:ACEVEDO-CRUZ, MARISOL (LMFT)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:ACEVEDO-CRUZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-2628
Mailing Address - Country:US
Mailing Address - Phone:860-568-6634
Mailing Address - Fax:
Practice Address - Street 1:555 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-3019
Practice Address - Country:US
Practice Address - Phone:860-756-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001173106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist