Individual
DESTINY CORDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
42 EDWARDS ST, SOUTHBRIDGE, MA 01550-1937
(774) 318-1806
Mailing address
113 SNOW RD, WEST BROOKFIELD, MA 01585-2700
(774) 334-4741
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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