MEDICARE: DR. EMILY PETERMAN CABANO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY.0006275	CO
2	103TC0700X	Clinical Psychologist	39776	TX

General Provider Information

NPI Number	:	1871303008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY PETERMAN CABANO PH.D.

Provider Business Mailing Address
First Line	:	6547 N ACADEMY BLVD # 1232
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80918-8342
Country	:	US
Telephone Number	:	520-248-1644
Fax Number	:

Provider Business Practice Location Address
First Line	:	6547 N ACADEMY BLVD # 1232
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80918-8342
Country	:	US
Telephone Number	:	520-248-1644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2025
Last Update Date	:	01/09/2025

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