Provider Demographics
NPI:1518136621
Name:CORDON-SHIVER, REGINE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REGINE
Middle Name:M
Last Name:CORDON-SHIVER
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 1:19425 SW 58TH MNR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3338
Mailing Address - Country:US
Mailing Address - Phone:954-252-3072
Mailing Address - Fax:954-252-0738
Practice Address - Street 1:19425 SW 58TH MNR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-3338
Practice Address - Country:US
Practice Address - Phone:954-252-3072
Practice Address - Fax:954-252-0738
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00040951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical