Basic Information
| Provider Information | |||||||||
| NPI: | 1013110204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDARO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94 BATCHELOR ST | ||||||||
| Address2: | |||||||||
| City: | GRANBY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010339729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137390882 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 130 MAPLE ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011032214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137390882 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 5537 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1307819 | 05 | MA | MEDICAID |