Provider Demographics
NPI:1063747533
Name:CORDOLIANI, NILDE S (PHD)
Entity type:Individual
Prefix:
First Name:NILDE
Middle Name:S
Last Name:CORDOLIANI
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 1:1915 CALLE ZARINA
Mailing Address - Street 2:VALLE REAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0510
Mailing Address - Country:US
Mailing Address - Phone:787-975-9968
Mailing Address - Fax:
Practice Address - Street 1:2604 AVE LAS AMERICAS
Practice Address - Street 2:CONSTANCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2107
Practice Address - Country:US
Practice Address - Phone:787-844-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical