Provider Demographics
NPI:1063436871
Name:CABANNE, EDWARD D (MSW LCSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:D
Last Name:CABANNE
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 STARDUST ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-1725
Mailing Address - Country:US
Mailing Address - Phone:916-630-0289
Mailing Address - Fax:
Practice Address - Street 1:855 HOWE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3912
Practice Address - Country:US
Practice Address - Phone:916-929-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical