MEDICARE: CORDERO RAYMON HAWKINS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1831842772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORDERO RAYMON HAWKINS

Provider Business Mailing Address
First Line	:	7200 CYPRESS LAKES APARTMENT BLVD APT 1012
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-5312
Country	:	US
Telephone Number	:	225-205-0724
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 CYPRESS LAKES APARTMENT BLVD APT 1012
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-5312
Country	:	US
Telephone Number	:	225-205-0724
Fax Number	:

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

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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