Provider Demographics
NPI:1215440441
Name:COLON CRUZ, IVELISSE (LSW)
Entity type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:COLON CRUZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 ZOELLNERS PL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1026
Mailing Address - Country:US
Mailing Address - Phone:513-505-9809
Mailing Address - Fax:
Practice Address - Street 1:1505 ELM ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-6906
Practice Address - Country:US
Practice Address - Phone:513-352-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.17013471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical