Individual
JEREMY CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
9201 MONTGOMERY BLVD NE BLDG 5, ALBUQUERQUE, NM 87111-2468
(505) 217-1717
Mailing address
9201 MONTGOMERY BLVD NE BLDG 5, ALBUQUERQUE, NM 87111-2468
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWB-2023-0533
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SWB-2023-0533
LMSW
NM
Enumeration date
02/26/2020
Last updated
06/14/2023
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