Provider Demographics
NPI:1235577370
Name:CORDERO, SAMANTHA ANN (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:CORDERO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2020
Mailing Address - Country:US
Mailing Address - Phone:908-892-4692
Mailing Address - Fax:908-892-4692
Practice Address - Street 1:500 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2135
Practice Address - Country:US
Practice Address - Phone:908-725-2800
Practice Address - Fax:908-704-1790
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00192000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701OtherAGENCY MEDICAID PROVIDER NUMBER