Provider Demographics
NPI:1164203683
Name:CABRERA PEREZ, MADELAINE
Entity Type:Individual
Prefix:
First Name:MADELAINE
Middle Name:
Last Name:CABRERA PEREZ
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 1:12101 BIRD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3553
Mailing Address - Country:US
Mailing Address - Phone:786-560-7699
Mailing Address - Fax:
Practice Address - Street 1:12101 BIRD DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3553
Practice Address - Country:US
Practice Address - Phone:786-560-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-121075106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician