Provider Demographics
NPI:1265499248
Name:CABALLERO, JUAN M (PSY D)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALLE CALAZAN LASALLE STE 3
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4178
Mailing Address - Country:US
Mailing Address - Phone:787-308-5696
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE CALAZAN LASALLE STE 3
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4178
Practice Address - Country:US
Practice Address - Phone:787-349-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical