Provider Demographics
NPI:1114481124
Name:CORDERO, SABRINA CORDERO MARIA
Entity Type:Individual
Prefix:MS
First Name:SABRINA CORDERO
Middle Name:MARIA
Last Name:CORDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ISLAND ST APT 319
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1827
Mailing Address - Country:US
Mailing Address - Phone:978-996-0475
Mailing Address - Fax:
Practice Address - Street 1:50 ISLAND ST APT 319
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1827
Practice Address - Country:US
Practice Address - Phone:978-996-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMTN960144593OtherBLUECROSS BLUESHIELD