Provider Demographics
NPI:1932552668
Name:CRUZ, MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 SUNRISE CT
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3988
Mailing Address - Country:US
Mailing Address - Phone:773-655-2246
Mailing Address - Fax:
Practice Address - Street 1:450 W 22ND ST
Practice Address - Street 2:STE 158
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6014
Practice Address - Country:US
Practice Address - Phone:630-474-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12037101YM0800X, 1041C0700X
IL1490162831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health