Basic Information
| Provider Information | |||||||||
| NPI: | 1972650968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | AJA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW, AAC, LICSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RAMOS | ||||||||
| OtherFirstName: | AJA | ||||||||
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| OtherCredential: | MSW, RC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1600 E OLIVE ST | ||||||||
| Address2: | SEATTLE MENTAL HEALTH | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022200 | ||||||||
| FaxNumber: | 2063022210 | ||||||||
| Practice Location | |||||||||
| Address1: | 2719 E MADISON ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981124752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022961 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60149901 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | CG60149901 | WA | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | LW60281199 | WA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | LW60281199 | WA | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.