Provider Demographics
NPI:1164073326
Name:CABRAL, VICTOR A
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:A
Last Name:CABRAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 BOLTON NOTCH PL
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3414
Mailing Address - Country:US
Mailing Address - Phone:717-400-1871
Mailing Address - Fax:
Practice Address - Street 1:5137 DEVONSHIRE RD STE G
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3919
Practice Address - Country:US
Practice Address - Phone:717-400-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1361901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty