Provider Demographics
NPI:1225500911
Name:CORDOVA, ROSARIO MARIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:MARIA
Last Name:CORDOVA
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 1:952 CORONADO CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1602
Mailing Address - Country:US
Mailing Address - Phone:805-231-2590
Mailing Address - Fax:
Practice Address - Street 1:254 W HARVARD BLVD STE D
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3919
Practice Address - Country:US
Practice Address - Phone:805-231-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty