1528181302 NPI number — MS. CARMEN M CRUZ-MERCER LICSW

Table of content: MS. CARMEN M CRUZ-MERCER LICSW (NPI 1528181302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528181302 NPI number — MS. CARMEN M CRUZ-MERCER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ-MERCER
Provider First Name:
CARMEN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRUZ
Provider Other First Name:
CARMEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528181302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
637 WASHINGTON ST
Provider Second Line Business Mailing Address:
CODMAN SQUARE HEALTH CNT
Provider Business Mailing Address City Name:
DORCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-822-8242
Provider Business Mailing Address Fax Number:
617-822-8148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
637 WASHINGTON ST
Provider Second Line Business Practice Location Address:
CODMAN SQUARE HEALTH CNT
Provider Business Practice Location Address City Name:
DORCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-822-8242
Provider Business Practice Location Address Fax Number:
617-822-8148
Provider Enumeration Date:
04/09/2007

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: 1041C0700X , with the licence number:  1028356 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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