Juan Carlos Cordero, M.S., M.A., PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002740 Issued in PR

Practice address

1061 Harmon Ave
Fort Stewart, GA 31314-5641

Phone

(129) 435-7375

NPI assigned

Jul 15, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Dr. Juan Carlos Cordero Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Health Resources, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Windsor, CT
  • NPI 1215979810
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1831506476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-7375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "129-435-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDERO",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "name_prefix": "Dr.",
        "credential": "M.S., M.A., PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-15",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PR",
            "license": "002740",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "2740",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "002740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUAN",
            "last_name": "CORDERO",
            "middle_name": "CARLOS",
            "prefix": "DR.",
            "credential": "M.A. , M.S, PSY.D",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Larissa Conolly, AUD
• Linda Carolyn Cooke, LCSW
• Cory Edward Cookingham Jr., M.D.
• Joshua Coons, PHARM.D.
• Sharon Lee Cooper
• Bradley Heyward Cornell, DPT
• Jennifer Corpus, LPN
• Siegfred Corpus
• Barbara Anne Corroto
• Debra L Cosby, PHARMD

• Clinical Psychologist in Fort Stewart, GA
• Providers in Fort Stewart, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.