Provider Demographics
NPI:1407472632
Name:CABRERA ACREE, KEREN
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:CABRERA ACREE
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 1:7145 MIAMI LAKES DR APT R13
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6950
Mailing Address - Country:US
Mailing Address - Phone:305-590-3835
Mailing Address - Fax:
Practice Address - Street 1:7145 MIAMI LAKES DR APT R13
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6950
Practice Address - Country:US
Practice Address - Phone:305-590-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20120588106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107305200Medicaid