Individual
DR. JAMES VICTOR CORDOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
48 CEDAR ST, WORCESTER, MA 01609-2134
(508) 612-0426
Mailing address
2 SUN VALLEY DR, WORCESTER, MA 01609-1414
(508) 798-5412
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
8110
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0502740
MASS HEALTH PROVIDER #
MA
01
—
W06321
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/12/2007
Last updated
07/08/2007
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