Provider Demographics
NPI:1891073433
Name:CABALLERO, AMBERLY BROOK (MSED, BCBA, BSL, IEC)
Entity Type:Individual
Prefix:MRS
First Name:AMBERLY
Middle Name:BROOK
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:MSED, BCBA, BSL, IEC
Other - Prefix:
Other - First Name:ELEVATED
Other - Middle Name:
Other - Last Name:KIDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1439 LONGLEAF CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7890
Mailing Address - Country:US
Mailing Address - Phone:267-978-4305
Mailing Address - Fax:
Practice Address - Street 1:1010 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2334
Practice Address - Country:US
Practice Address - Phone:267-978-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst