Provider Demographics
NPI:1700096112
Name:CABANILLA, ELBA M (PHD)
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:M
Last Name:CABANILLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARQUE DE TORRIMAR
Mailing Address - Street 2:CALLE 6 F17
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-644-2698
Mailing Address - Fax:
Practice Address - Street 1:HEAD START MUNICIPIO GUAYAMA
Practice Address - Street 2:CALLE BADE PEREZ 6
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical