Provider Demographics
NPI:1205373636
Name:CORDOVA ARISCO, AILI (LCSW)
Entity Type:Individual
Prefix:
First Name:AILI
Middle Name:
Last Name:CORDOVA ARISCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 S MERIDEN RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2954
Mailing Address - Country:US
Mailing Address - Phone:203-843-3618
Mailing Address - Fax:
Practice Address - Street 1:298 S MERIDEN RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2954
Practice Address - Country:US
Practice Address - Phone:203-843-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0090011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical