Provider Demographics
NPI:1942800669
Name:CORDERO, NAYDA IVELISSE (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MISS
First Name:NAYDA
Middle Name:IVELISSE
Last Name:CORDERO
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0789
Mailing Address - Country:US
Mailing Address - Phone:939-245-2711
Mailing Address - Fax:
Practice Address - Street 1:MOCA PROFESSIONAL PLAZA PR111 INT PR 110 KM 14.5
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-641-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical