Provider Demographics
NPI:1083290266
Name:CEBALLO, DAENA
Entity Type:Individual
Prefix:MISS
First Name:DAENA
Middle Name:
Last Name:CEBALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16127 RAMBLING VINE DR E
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1194
Mailing Address - Country:US
Mailing Address - Phone:813-495-8727
Mailing Address - Fax:
Practice Address - Street 1:1503 S US HIGHWAY 301 # E16
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5126
Practice Address - Country:US
Practice Address - Phone:813-591-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical