Provider Demographics
NPI:1609609650
Name:NECKLES, CORDELIA B
Entity type:Individual
Prefix:
First Name:CORDELIA
Middle Name:B
Last Name:NECKLES
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 1:461 GROVE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-4571
Mailing Address - Country:US
Mailing Address - Phone:929-368-9786
Mailing Address - Fax:
Practice Address - Street 1:461 GROVE ST APT 2
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-4571
Practice Address - Country:US
Practice Address - Phone:929-368-9786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician