Individual
DEIDRA MARIE CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2534 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4971
(505) 617-1180
Mailing address
624 UNIVERSITY AVE, LAS VEGAS, NM 87701-4278
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-09998
NM
1041C0700X
Clinical Social Worker
Primary
C-10903
NM
Other
Enumeration date
12/04/2017
Last updated
05/07/2021
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