Provider Demographics
NPI:1578172565
Name:CORDOVA, BERNADINE GARCIA (LMSW)
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:GARCIA
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BERNADINE
Other - Middle Name:GARCIA
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 S ABILENE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6380
Mailing Address - Country:US
Mailing Address - Phone:575-356-7000
Mailing Address - Fax:
Practice Address - Street 1:501 S ABILENE AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6380
Practice Address - Country:US
Practice Address - Phone:575-356-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07416104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker