MEDICARE: NAZARENA CORDERO LCAT

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	101Y00000X	Counselor	001352-1	NY
2	101Y00000X	Counselor	001352	NY

General Provider Information

NPI Number	:	1821395591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAZARENA CORDERO LCAT

Provider Business Mailing Address
First Line	:	5305 GREENWOOD AVE STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2448
Country	:	US
Telephone Number	:	917-573-8056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 GREENWOOD AVE STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2448
Country	:	US
Telephone Number	:	917-573-8056
Fax Number	:

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

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	03/12/2021

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Directions to “ NAZARENA CORDERO LCAT” Practice Location

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