Provider Demographics
NPI:1710592829
Name:CORDEIRO, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CORDEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 ADELINE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2579
Mailing Address - Country:US
Mailing Address - Phone:510-848-1112
Mailing Address - Fax:510-848-4445
Practice Address - Street 1:3075 ADELINE ST STE 120
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2579
Practice Address - Country:US
Practice Address - Phone:510-848-1112
Practice Address - Fax:510-848-4445
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSB94028359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist