Provider Demographics
NPI:1346043908
Name:SANTA CRUZ, CLARISSA MARIE
Entity type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:MARIE
Last Name:SANTA CRUZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 COUNTY CORK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3103
Mailing Address - Country:US
Mailing Address - Phone:210-632-1840
Mailing Address - Fax:
Practice Address - Street 1:119 SW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2101
Practice Address - Country:US
Practice Address - Phone:210-745-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician