Healthcare Provider Details

I. General information

NPI: 1992732788
Provider Name (Legal Business Name): DR. ARACELI CABARCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E SOUTHWIND RD
SPRINGFIELD IL
62703-5125
US

IV. Provider business mailing address

7112 GARDENVIEW LN
SPRINGFIELD IL
62712-8907
US

V. Phone/Fax

Practice location:
  • Phone: 217-720-6912
  • Fax:
Mailing address:
  • Phone: 217-270-6912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071010232
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number203117
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0005085
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number099819
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: