Provider Demographics
NPI:1891864211
Name:CIORDIA, JOHANNA MARIELA (MA)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIELA
Last Name:CIORDIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. JARDINES DE DORADO
Mailing Address - Street 2:CALLE 8 A-12
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:939-969-4115
Mailing Address - Fax:
Practice Address - Street 1:URB. FLAMBOYAN
Practice Address - Street 2:C-11 3 STREET
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:939-644-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2323103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist