Provider Demographics
NPI:1023245735
Name:CORDERO MENDEZ, GRISSELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:GRISSELLE
Middle Name:
Last Name:CORDERO MENDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 AVE PEDRO ALBIZU CAMPOS
Mailing Address - Street 2:SUITE #2
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5959
Mailing Address - Country:US
Mailing Address - Phone:939-339-1402
Mailing Address - Fax:
Practice Address - Street 1:2045 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:SUITE #2
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5959
Practice Address - Country:US
Practice Address - Phone:939-339-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-20
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical