Healthcare Provider Details

I. General information

NPI: 1740126564
Provider Name (Legal Business Name): MARIA CORDOBA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 NE 107TH ST
MIAMI SHORES FL
33161-7355
US

IV. Provider business mailing address

1030 NE 107TH ST
MIAMI SHORES FL
33161-7355
US

V. Phone/Fax

Practice location:
  • Phone: 404-704-2609
  • Fax: 404-704-2609
Mailing address:
  • Phone: 404-704-2609
  • Fax: 404-704-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: