Provider Demographics
NPI:1629109459
Name:CABRERA, JOSE L (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:CABRERA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1928
Mailing Address - Country:US
Mailing Address - Phone:401-415-8844
Mailing Address - Fax:401-383-5737
Practice Address - Street 1:355 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1928
Practice Address - Country:US
Practice Address - Phone:401-415-8844
Practice Address - Fax:401-383-5737
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068951101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY136167177OtherFIDELIS