1366689325 NPI number — MS. MARIA LOURDES CORDERO LCSW

Table of content: MS. MARIA LOURDES CORDERO LCSW (NPI 1366689325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366689325 NPI number — MS. MARIA LOURDES CORDERO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDERO
Provider First Name:
MARIA
Provider Middle Name:
LOURDES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUDDEN
Provider Other First Name:
MARIA
Provider Other Middle Name:
CORDERO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366689325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MADISON AVENUE
Provider Second Line Business Mailing Address:
CHILD DEVELOPMENT CENTER BOX 100 MORRISTOWN MEMORIAL HO
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07962-1956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-971-4208
Provider Business Mailing Address Fax Number:
973-290-7164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MADISON AVENUE
Provider Second Line Business Practice Location Address:
CHILD DEVELOPMENT CENTER BOX 100 MORRISTOWN MEMORIAL HO
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07962-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-971-4208
Provider Business Practice Location Address Fax Number:
973-290-7164
Provider Enumeration Date:
01/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04991000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)