Provider Demographics
NPI:1992821045
Name:CABRERA, AGUEDA ADELA (MFT)
Entity type:Individual
Prefix:MRS
First Name:AGUEDA
Middle Name:ADELA
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:AGUEDA
Other - Middle Name:ADELA
Other - Last Name:ORSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:15339 SATICOY ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3345
Mailing Address - Country:US
Mailing Address - Phone:818-267-2657
Mailing Address - Fax:818-267-2691
Practice Address - Street 1:110 N MACLAY AVE STE 109
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2986
Practice Address - Country:US
Practice Address - Phone:818-326-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist