Individual
DIANA CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
46 ALBION ST, BRIDGEPORT, CT 06605-2602
(203) 330-3155
(203) 330-6008
Mailing address
46 ALBION ST, BRIDGEPORT, CT 06605-2602
(203) 330-3155
(203) 330-6008
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
000478
CT
1041C0700X
Clinical Social Worker
5400
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000478
CT LICENSE
CT
Enumeration date
06/05/2014
Last updated
05/12/2015
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