Active NPI
Charles Cordova, MHC-LP
- Mental Health Counselor
- New York, NY
National Provider Identifier
1578095329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- P03157
- Practice address
- 248 W 108TH St
The Bridge 5TH FL Clinic
New York, NY 10025-2956 - Phone
- (718) 542-8080
- NPI assigned
- Mar 31, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P03157 | NY | Primary |
Addresses
Primary practice location
248 W 108TH St
The Bridge 5TH FL Clinic
New York, NY 10025-2956
Mailing address
248 W 108TH St
The Bridge 5TH FL Clinic
New York, NY 10025-2956
Phone (718) 542-8080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P03157 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490918400000",
"number": "1578095329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 W 108TH ST",
"address_2": "THE BRIDGE 5TH FL CLINIC",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100252956",
"telephone_number": "718-542-8080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 W 108TH ST",
"address_2": "THE BRIDGE 5TH FL CLINIC",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100252956",
"telephone_number": "718-542-8080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDOVA",
"first_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MHC-LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-31",
"last_updated": "2017-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "P03157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.