Provider Demographics
NPI:1538036868
Name:CRUZ, MARISOL (CASAC-T)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W 166TH ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4212
Mailing Address - Country:US
Mailing Address - Phone:917-492-0990
Mailing Address - Fax:
Practice Address - Street 1:2271 3RD AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2231
Practice Address - Country:US
Practice Address - Phone:917-492-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty