Healthcare Provider Details

I. General information

NPI: 1396385100
Provider Name (Legal Business Name): JOCLYN CABANAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 INDIANOLA AVE
COLUMBUS OH
43201-2118
US

IV. Provider business mailing address

245 E 13TH AVE APT B6
COLUMBUS OH
43201-1990
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-2661
  • Fax: 614-294-3247
Mailing address:
  • Phone: 740-341-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: