Provider Demographics
NPI:1780847236
Name:CABRERA, CARLOS A (RI-C0807040910)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:CABRERA
Suffix:
Gender:M
Credentials:RI-C0807040910
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5035
Mailing Address - Country:US
Mailing Address - Phone:562-218-3639
Mailing Address - Fax:
Practice Address - Street 1:1601 E 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5035
Practice Address - Country:US
Practice Address - Phone:562-218-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2008-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-C0807040910101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)