Provider Demographics
NPI:1154811073
Name:CRUZ, JORGE (LMHC, CAP, CRC)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LMHC, CAP, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 N POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-5432
Mailing Address - Country:US
Mailing Address - Phone:813-326-8049
Mailing Address - Fax:
Practice Address - Street 1:1910 ORIENT RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-3354
Practice Address - Country:US
Practice Address - Phone:813-630-4673
Practice Address - Fax:813-630-4670
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP0100184101YA0400X
FLMH22062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)