Provider Demographics
NPI:1235599440
Name:CORDIS, KELLI (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:CORDIS
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 1:30 DANUBE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2832
Mailing Address - Country:US
Mailing Address - Phone:773-350-7602
Mailing Address - Fax:
Practice Address - Street 1:30 DANUBE RIVER DR
Practice Address - Street 2:SUITE 616
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2832
Practice Address - Country:US
Practice Address - Phone:773-350-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW132371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical