Provider Demographics
NPI:1336917095
Name:CABRERA, YESENIA GLORIA (CBHCM)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:GLORIA
Last Name:CABRERA
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ROYAL PALM RD APT 110
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4610
Mailing Address - Country:US
Mailing Address - Phone:863-512-7702
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 191
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1084
Practice Address - Country:US
Practice Address - Phone:863-512-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-263610106S00000X
FLCBHCM.0106102-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator