Provider Demographics
NPI:1861528176
Name:CORDERO, DUSTINA OMA (LCSW)
Entity type:Individual
Prefix:
First Name:DUSTINA
Middle Name:OMA
Last Name:CORDERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DUSTINA
Other - Middle Name:OMA
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5584 GLOWHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-8748
Mailing Address - Country:US
Mailing Address - Phone:530-218-0314
Mailing Address - Fax:530-618-8031
Practice Address - Street 1:5584 GLOWHAVEN ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-8748
Practice Address - Country:US
Practice Address - Phone:530-218-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA821751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor