Provider Demographics
NPI:1568169530
Name:CABRERA CHAVEZ, EILEEN (RBT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:CABRERA CHAVEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21150 SW 87TH AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-7388
Mailing Address - Country:US
Mailing Address - Phone:786-803-1983
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST STE 114
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5919
Practice Address - Country:US
Practice Address - Phone:305-908-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-254466106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician