Provider Demographics
NPI:1043973183
Name:CORDOVA, CARLOS ALEXANDER (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALEXANDER
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2638
Mailing Address - Country:US
Mailing Address - Phone:718-775-0110
Mailing Address - Fax:
Practice Address - Street 1:6 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-2638
Practice Address - Country:US
Practice Address - Phone:718-775-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-47444103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty