Provider Demographics
NPI:1255169033
Name:CABRERA, TANIA (LCSW)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 VERACRUZ BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4763
Mailing Address - Country:US
Mailing Address - Phone:904-859-3119
Mailing Address - Fax:
Practice Address - Street 1:458 VERACRUZ BLVD
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4763
Practice Address - Country:US
Practice Address - Phone:904-859-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6888104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker