Provider Demographics
NPI:1407328768
Name:CORDES, MARYANNE CINDY (LMFT)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:CINDY
Last Name:CORDES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1613
Mailing Address - Country:US
Mailing Address - Phone:415-686-1813
Mailing Address - Fax:
Practice Address - Street 1:2233 HONOLULU AVE STE 304
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1635
Practice Address - Country:US
Practice Address - Phone:818-660-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist