Provider Demographics
NPI:1659441426
Name:CABALLERO, MICHAEL R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ALBERTA DRIVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-837-6705
Mailing Address - Fax:716-837-6759
Practice Address - Street 1:315 ALBERTA DRIVE
Practice Address - Street 2:SUITE 211
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-837-6705
Practice Address - Fax:716-837-6759
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0380391104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
6207255OtherINDEPENDENT HEALTH
000523528008OtherBLUE CROSS
00020323604OtherUNIVERA
000523528008OtherBLUE CROSS