Provider Demographics
NPI:1013557685
Name:CABAN, VICTORINA (STATE CERTIFICATION)
Entity Type:Individual
Prefix:MRS
First Name:VICTORINA
Middle Name:
Last Name:CABAN
Suffix:
Gender:F
Credentials:STATE CERTIFICATION
Other - Prefix:
Other - First Name:VICTORINA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD ED, SP ED
Mailing Address - Street 1:5129 47TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7329
Mailing Address - Country:US
Mailing Address - Phone:917-853-1412
Mailing Address - Fax:
Practice Address - Street 1:5129 47TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7329
Practice Address - Country:US
Practice Address - Phone:917-853-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst