Healthcare Provider Details

I. General information

NPI: 1609607845
Provider Name (Legal Business Name): JULIETTA COZZA-CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: J COZZA-CORDERO

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 COURTLANDT AVE
BRONX NY
10451-5013
US

IV. Provider business mailing address

418 E 88TH ST APT 3A
NEW YORK NY
10128-6653
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax:
Mailing address:
  • Phone: 917-647-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: