Provider Demographics
NPI:1154551034
Name:CRUZ, SOR INES (MRC)
Entity type:Individual
Prefix:MS
First Name:SOR
Middle Name:INES
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 FOUR LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1247
Mailing Address - Country:US
Mailing Address - Phone:321-253-1566
Mailing Address - Fax:
Practice Address - Street 1:4446 FOUR LAKES DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1247
Practice Address - Country:US
Practice Address - Phone:321-253-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00815101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor