Provider Demographics
NPI:1982111977
Name:CORDERO, GISELA (MS)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 URB HACIENDAS DE CAMUY
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2860
Mailing Address - Country:US
Mailing Address - Phone:787-412-4855
Mailing Address - Fax:
Practice Address - Street 1:220 URB HACIENDAS DE CAMUY
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2860
Practice Address - Country:US
Practice Address - Phone:787-412-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5916103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling