Provider Demographics
NPI:1821770777
Name:CABALLERO GOMEZ, ANACELYS (MSW)
Entity Type:Individual
Prefix:
First Name:ANACELYS
Middle Name:
Last Name:CABALLERO GOMEZ
Suffix:
Gender:F
Credentials:MSW
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 265
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0265
Mailing Address - Country:US
Mailing Address - Phone:787-329-1874
Mailing Address - Fax:
Practice Address - Street 1:STATE HIGHWAY PR 726
Practice Address - Street 2:100 STREET JOSE C VAZQUEZ
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-714-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR145741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical