Provider Demographics
NPI:1982708004
Name:CABOT, MITHRAN GODFREY
Entity Type:Individual
Prefix:
First Name:MITHRAN
Middle Name:GODFREY
Last Name:CABOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MITHRAN
Other - Middle Name:
Other - Last Name:CABOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:308 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-9194
Mailing Address - Country:US
Mailing Address - Phone:386-585-0293
Mailing Address - Fax:
Practice Address - Street 1:308 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-9194
Practice Address - Country:US
Practice Address - Phone:386-585-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health