Provider Demographics
NPI:1891214151
Name:CORDERO, JESSICA (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WESTFIELD AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1234
Mailing Address - Country:US
Mailing Address - Phone:443-453-2101
Mailing Address - Fax:
Practice Address - Street 1:2328 W JOPPA RD STE 10
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4613
Practice Address - Country:US
Practice Address - Phone:877-979-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty