Provider Demographics
NPI:1124445663
Name:DA CRUZ, LA'SHONDRA MONIQUE (MS)
Entity type:Individual
Prefix:MRS
First Name:LA'SHONDRA
Middle Name:MONIQUE
Last Name:DA CRUZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LA'SHONDRA
Other - Middle Name:MONIQUE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:81 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3352
Mailing Address - Country:US
Mailing Address - Phone:203-243-0060
Mailing Address - Fax:
Practice Address - Street 1:93 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3933
Practice Address - Country:US
Practice Address - Phone:203-777-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-22
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health