Provider Demographics
NPI:1528181526
Name:CORDICE, SHARON HERMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:HERMAN
Last Name:CORDICE
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 1:6376 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2730
Mailing Address - Country:US
Mailing Address - Phone:619-287-5173
Mailing Address - Fax:
Practice Address - Street 1:9335 HAZARD WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1222
Practice Address - Country:US
Practice Address - Phone:858-495-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 154021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical