Provider Demographics
NPI:1497293872
Name:JOCELYN G CORDERO LLC
Entity Type:Organization
Organization Name:JOCELYN G CORDERO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-343-2829
Mailing Address - Street 1:PO BOX 11224
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-6224
Mailing Address - Country:US
Mailing Address - Phone:808-343-2829
Mailing Address - Fax:833-804-2660
Practice Address - Street 1:688 KINOOLE ST STE 110A
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3868
Practice Address - Country:US
Practice Address - Phone:808-343-2829
Practice Address - Fax:833-804-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI496251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health