Provider Demographics
NPI:1306280615
Name:CABALLERO, MARILLEN D (MED)
Entity type:Individual
Prefix:
First Name:MARILLEN
Middle Name:D
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WEBB DR STE C
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3921
Mailing Address - Country:US
Mailing Address - Phone:863-438-6806
Mailing Address - Fax:863-582-9396
Practice Address - Street 1:131 WEBB DR STE C
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3921
Practice Address - Country:US
Practice Address - Phone:863-438-6806
Practice Address - Fax:863-582-9396
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health