Provider Demographics
NPI:1346508579
Name:CABALLERO, MARIA JESUS (CATCIV,LAADC,CCS,CCJ)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JESUS
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:CATCIV,LAADC,CCS,CCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 CALLE REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1002
Mailing Address - Country:US
Mailing Address - Phone:805-681-4304
Mailing Address - Fax:805-681-4379
Practice Address - Street 1:4436 CALLE REAL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1002
Practice Address - Country:US
Practice Address - Phone:805-681-4304
Practice Address - Fax:805-681-4379
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960022-IV101YA0400X
CACCS-09034101YA0400X
CACJP 1731211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)