Provider Demographics
NPI:1043588619
Name:CABRERA, MIRTA LILIAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MIRTA
Middle Name:LILIAN
Last Name:CABRERA
Suffix:
Gender:F
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:W299S6091 GENESEE PASS
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-5885
Mailing Address - Country:US
Mailing Address - Phone:920-889-7200
Mailing Address - Fax:
Practice Address - Street 1:W299S6091 GENESEE PASS
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-5885
Practice Address - Country:US
Practice Address - Phone:920-889-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5173-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional