Healthcare Provider Details

I. General information

NPI: 1215769054
Provider Name (Legal Business Name): LIFE WITH A CUP OF JO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 04/16/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NORTH WALNUT STREET SUITE 108
MILFORD DE
19963-1467
US

IV. Provider business mailing address

386 WALMART DR STE 7 PMB 18
CAMDEN DE
19934-1374
US

V. Phone/Fax

Practice location:
  • Phone: 808-343-2829
  • Fax: 833-804-2660
Mailing address:
  • Phone: 808-343-2829
  • Fax: 833-804-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN G CORDERO
Title or Position: PSYCHOTHERAPIST
Credential: LMFT
Phone: 808-343-2829