Provider Demographics
NPI:1912734179
Name:CABRERA, MAXIMO ARIEL
Entity type:Individual
Prefix:
First Name:MAXIMO
Middle Name:ARIEL
Last Name:CABRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 W 53RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2426
Mailing Address - Country:US
Mailing Address - Phone:786-689-1196
Mailing Address - Fax:
Practice Address - Street 1:18441 NW 2ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4572
Practice Address - Country:US
Practice Address - Phone:305-400-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-373615106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician