Provider Demographics
NPI:1922575836
Name:CORDEIRO, MARIA CLARA
Entity Type:Individual
Prefix:
First Name:MARIA CLARA
Middle Name:
Last Name:CORDEIRO
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 1:1525 WISCONSIN AVE STE 141
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1995
Mailing Address - Country:US
Mailing Address - Phone:414-847-5722
Mailing Address - Fax:
Practice Address - Street 1:1525 WISCONSIN AVE STE 141
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1995
Practice Address - Country:US
Practice Address - Phone:414-847-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty