Provider Demographics
NPI:1346951753
Name:CORDERO, STEVEN J (NA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:CORDERO
Suffix:
Gender:M
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E LEMON ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-4117
Mailing Address - Country:US
Mailing Address - Phone:863-256-9906
Mailing Address - Fax:
Practice Address - Street 1:114 E LEMON ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-4117
Practice Address - Country:US
Practice Address - Phone:863-256-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-247766106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician