Provider Demographics
NPI:1053413351
Name:CABALLERO, GEORGE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 411141
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041
Mailing Address - Country:US
Mailing Address - Phone:323-255-9421
Mailing Address - Fax:323-344-9084
Practice Address - Street 1:111 W BEVERLY BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4312
Practice Address - Country:US
Practice Address - Phone:323-255-9421
Practice Address - Fax:323-344-9084
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS115221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 11522OtherLICENSED SOCIAL WORKER
CAR36980Medicare ID - Type Unspecified