MEDICARE: MRS. ELAINE HERNANDEZ-CORDOVA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0684151	NY

General Provider Information

NPI Number	:	1154492825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELAINE HERNANDEZ-CORDOVA LCSW

Provider Business Mailing Address
First Line	:	99 MAIN ST STE 522
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-3109
Country	:	US
Telephone Number	:	845-540-1002
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 MAIN ST STE 522
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-3109
Country	:	US
Telephone Number	:	845-540-1002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	10/28/2025

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