Provider Demographics
NPI:1306333075
Name:CABALLERO, FRANCISCO J (CDPT)
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:J
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 PACIFIC AVE N
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-3300
Mailing Address - Country:US
Mailing Address - Phone:606-423-7873
Mailing Address - Fax:360-577-0269
Practice Address - Street 1:2204 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3300
Practice Address - Country:US
Practice Address - Phone:606-423-7873
Practice Address - Fax:360-577-0269
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60521562101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60521562OtherCHEMICAL DEPENDENCY PROFESSIONAL TRAINEE LICENSE
WA2103098Medicaid