Provider Demographics
NPI:1912144569
Name:DELACRUZ, LUIS CARLOS (LPC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:CARLOS
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2350
Mailing Address - Country:US
Mailing Address - Phone:201-346-9848
Mailing Address - Fax:
Practice Address - Street 1:56 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-2003
Practice Address - Country:US
Practice Address - Phone:973-754-8619
Practice Address - Fax:973-754-4777
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00196500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional