Provider Demographics
NPI:1790778975
Name:CABRERA, ALICIA (PHD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0400
Mailing Address - Country:US
Mailing Address - Phone:787-798-4848
Mailing Address - Fax:787-798-0454
Practice Address - Street 1:21-21 CARR 174
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6512
Practice Address - Country:US
Practice Address - Phone:787-798-4848
Practice Address - Fax:787-798-0454
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2041103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6-2525Medicare ID - Type UnspecifiedPROVIDER NUMBER