Provider Demographics
NPI:1548321524
Name:CORDTS, THERESA BLANCHE (PSYD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:BLANCHE
Last Name:CORDTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:07850-1507
Mailing Address - Country:US
Mailing Address - Phone:973-398-0407
Mailing Address - Fax:973-398-0420
Practice Address - Street 1:143 LANDING RD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1507
Practice Address - Country:US
Practice Address - Phone:973-398-0407
Practice Address - Fax:973-398-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042764Medicare PIN