Individual
JARELIZ ENID CORDOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 COMMERCIAL ST, HOLYOKE, MA 01040-4704
(413) 654-0258
Mailing address
80 COMMERCIAL ST, HOLYOKE, MA 01040-4704
(413) 665-4028
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
S67500351
MA
Other
Enumeration date
11/01/2018
Last updated
11/01/2018
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