Provider Demographics
NPI:1740604768
Name:CABALLERO, NINA (LCPC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:CABALLERO LANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 GAMBRILLS RD STE F
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1102
Mailing Address - Country:US
Mailing Address - Phone:443-569-8882
Mailing Address - Fax:
Practice Address - Street 1:1125 WEST STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:202-256-9320
Practice Address - Fax:443-782-0213
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health