Provider Demographics
NPI:1962169912
Name:CORDEIRO, TRISHA M
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:M
Last Name:CORDEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BLISS RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1420
Mailing Address - Country:US
Mailing Address - Phone:240-577-0150
Mailing Address - Fax:
Practice Address - Street 1:62 BLISS RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1420
Practice Address - Country:US
Practice Address - Phone:240-577-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1407306251OtherYOUTH VILLAGES