Healthcare Provider Details

I. General information

NPI: 1720762651
Provider Name (Legal Business Name): TYRONE RASHAAD CABRAL MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BROCK AVE
NEW BEDFORD MA
02744-1508
US

IV. Provider business mailing address

525 WASHINGTON ST
COVENTRY RI
02816-5471
US

V. Phone/Fax

Practice location:
  • Phone: 774-628-6083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1144108
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: