1457124554 NPI number — GUADALUPE ALEJANDRA NOGUEZ DE LA CRUZ MASTER PSYCHOLOGY

Table of content: GUADALUPE ALEJANDRA NOGUEZ DE LA CRUZ MASTER PSYCHOLOGY (NPI 1457124554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457124554 NPI number — GUADALUPE ALEJANDRA NOGUEZ DE LA CRUZ MASTER PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOGUEZ DE LA CRUZ
Provider First Name:
GUADALUPE
Provider Middle Name:
ALEJANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTER PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457124554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
933 E COLUMBUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01105-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-736-8329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 MAIN ST FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01420-3496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-228-3496
Provider Business Practice Location Address Fax Number:
978-342-1631
Provider Enumeration Date:
11/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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