Provider Demographics
NPI:1659007912
Name:CORDON, KETURA ESTHER
Entity Type:Individual
Prefix:
First Name:KETURA
Middle Name:ESTHER
Last Name:CORDON
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 1:504 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1445
Mailing Address - Country:US
Mailing Address - Phone:617-518-1050
Mailing Address - Fax:
Practice Address - Street 1:504 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02129-1445
Practice Address - Country:US
Practice Address - Phone:617-518-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor