Provider Demographics
NPI:1619685237
Name:CORDOVA, CYNTHIA JALEESA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JALEESA
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-1028
Mailing Address - Country:US
Mailing Address - Phone:203-725-5787
Mailing Address - Fax:
Practice Address - Street 1:1279 NOBLE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-1028
Practice Address - Country:US
Practice Address - Phone:203-725-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical