Provider Demographics
NPI:1558158071
Name:CORDERO, MYKAL
Entity type:Individual
Prefix:
First Name:MYKAL
Middle Name:
Last Name:CORDERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 E FALMOUTH HWY
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-6262
Mailing Address - Country:US
Mailing Address - Phone:774-238-2850
Mailing Address - Fax:
Practice Address - Street 1:558 WEST FALMOUTH HWY
Practice Address - Street 2:
Practice Address - City:WEST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536
Practice Address - Country:US
Practice Address - Phone:508-540-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)