NPIMap

Organization Active NPI

Maximo Delacruz Centro D Salud Mental LLC

  • Clinical Child & Adolescent Psychologist
  • Stafford, VA
National Provider Identifier
1205607744
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
MAXIMO DELACRUZ CENTRO D SALUD MENTAL LLC
Doing business as
MAXIMO Delacruz Centro D Salud Mental LLC
Practice address
31 Ontell CT
Stafford, VA 22554-1566
Phone
(571) 572-0050
Fax
(888) 315-4281
NPI assigned
Jan 12, 2024
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Maximo De la Cruz, BA-MANPI 1043875248
Title
Owner/Director
Phone
(571) 572-0050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X Primary

Addresses

Primary practice location

31 Ontell CT
Stafford, VA 22554-1566

Mailing address

31 Ontell CT
Stafford, VA 22554-1566
Phone (571) 572-0050

Other names 1

  • MAXIMO Delacruz Centro D Salud Mental LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1205607744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 ONTELL CT",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225541566",
            "telephone_number": "571-572-0050",
            "fax_number": "888-315-4281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 ONTELL CT",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225541566",
            "telephone_number": "571-572-0050",
            "fax_number": "888-315-4281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIMO DELACRUZ CENTRO D SALUD MENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "DE LA CRUZ",
        "authorized_official_first_name": "MAXIMO",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "571-572-0050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA-MA"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAXIMO Delacruz Centro D Salud Mental LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stafford, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.