Provider Demographics
NPI:1821833963
Name:CORDOVA, MICHAEL (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:CORDOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:260 CARR 932 APT 1032
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-7618
Mailing Address - Country:US
Mailing Address - Phone:787-432-0533
Mailing Address - Fax:
Practice Address - Street 1:175 DWIGHT RD STE 201B
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1576
Practice Address - Country:US
Practice Address - Phone:413-507-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor