=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073011664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JERE NICHOLE CABRAL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2018
-----------------------------------------------------
Last Update Date | 12/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 CASE AVE STE 1
-----------------------------------------------------
City | SEEKONK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02771-4156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-901-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 CASE AVE
-----------------------------------------------------
City | SEEKONK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02771-4156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-901-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 125365
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 03669
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------