Provider Demographics
NPI:1649508607
Name:MARIN CORDERO, REBECA AIMEE (PHD)
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:AIMEE
Last Name:MARIN CORDERO
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 1:14655 NE BEL RED RD STE 203
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3900
Mailing Address - Country:US
Mailing Address - Phone:206-685-4927
Mailing Address - Fax:
Practice Address - Street 1:14655 NE BEL RED RD STE 203
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3900
Practice Address - Country:US
Practice Address - Phone:206-685-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WAPY60608622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist