Provider Demographics
NPI:1740366608
Name:CABRAL, SUSAN J (LICSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:CABRAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LAWNDALE CIR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5159
Mailing Address - Country:US
Mailing Address - Phone:978-290-7090
Mailing Address - Fax:
Practice Address - Street 1:7 KIMBALL LANE
Practice Address - Street 2:BUILDING C
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940
Practice Address - Country:US
Practice Address - Phone:781-245-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4351OtherLICSW
MAPO4351Medicare ID - Type UnspecifiedLICSW