Provider Demographics
NPI:1366023293
Name:CABRAL, MARISSA KATE
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KATE
Last Name:CABRAL
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 1:1785 E SAHARA AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3759
Mailing Address - Country:US
Mailing Address - Phone:702-252-8342
Mailing Address - Fax:702-252-8349
Practice Address - Street 1:1785 E SAHARA AVE STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3759
Practice Address - Country:US
Practice Address - Phone:702-252-8342
Practice Address - Fax:702-252-8349
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7527-S1041C0700X
NV7527-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1802469358Medicaid