Provider Demographics
NPI:1831246479
Name:CORDERO, LUZ-MARITZA (MA, LCPC)
Entity type:Individual
Prefix:
First Name:LUZ-MARITZA
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 N TROY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3427
Mailing Address - Country:US
Mailing Address - Phone:773-315-8625
Mailing Address - Fax:773-279-8168
Practice Address - Street 1:3166 N LINCOLN AVE STE 304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:773-315-8625
Practice Address - Fax:773-279-8168
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635030OtherBCBS