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General NPI Number Information
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NPI Number | 1417839101
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Entity Type | Individual
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Provider Name | MARIAM CORDERO
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Gender | Female
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1501 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32804-7120
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Country | US
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Telephone | 321-430-5866
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Fax |
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Provider Business Mailing Address
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Address Line | 5020 REVOLUTIONARY WAY
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1864
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Country | US
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Telephone | 954-348-8179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | IMT4308
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License Number State | FL
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