MEDICARE: SELENA MARYCRUZ CABALLERO MOLINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	ACSW111634	CA
2	1041C0700X	Clinical Social Worker	137563	CA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	104100000X	Social Worker	ACSW111634	CA

General Provider Information

NPI Number	:	1225703168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA MARYCRUZ CABALLERO MOLINA

Provider Business Mailing Address
First Line	:	3210 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5062
Country	:	US
Telephone Number	:	562-548-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5062
Country	:	US
Telephone Number	:	562-548-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	05/01/2026

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