Healthcare Provider Details

I. General information

NPI: 1649769548
Provider Name (Legal Business Name): BRANDON LAMAR CABRERO QMHS, CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-3508
US

IV. Provider business mailing address

1969 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-3508
US

V. Phone/Fax

Practice location:
  • Phone: 614-400-8823
  • Fax:
Mailing address:
  • Phone: 614-987-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA191704
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: