Provider Demographics
NPI:1366769143
Name:SANTA CRUZ, SUSAN (PHD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:SANTA CRUZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32821
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-2821
Mailing Address - Country:US
Mailing Address - Phone:520-661-2216
Mailing Address - Fax:520-844-3100
Practice Address - Street 1:2230 E SPEEDWAY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4761
Practice Address - Country:US
Practice Address - Phone:520-661-2216
Practice Address - Fax:520-844-3100
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical