Individual ProviderJames Victor CordovaPsychologistBehavioral Health & Social Service ProvidersPractice Address48 Cedar St, Worcester, MA 01609-2134(508) 612-0426(508) 798-5412PECOS EnrollmentThis provider is enrolled in PECOS as JAMES CORDOVA.Based on the most recent information from CMS, provider James Victor Cordova is legally eligible to order and refer claims for DME services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1427108034Provider TypeIndividualFull NameCordova, James VictorTitleDr.CredentialPH.D.GenderMaleSole ProprietorYesEnumeration Date1/12/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address48 Cedar St, Worcester, MA 01609-2134Phone(508) 612-0426FaxUnlisted FaxMailing LocationMailing Address2 Sun Valley Dr, Worcester, MA 01609-1414Phone(508) 798-5412FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode103TC0700XPrimaryDescriptionPsychologistBehavioral Health & Social Service ProvidersLicense8110MassachusettsProvider IdentifiersIDDescriptionIssuerID0502740DescriptionOtherIssuerMASS HEALTH PROVIDER #MassachusettsIDW06321DescriptionOtherIssuerBLUE CROSS BLUE SHIELDMassachusetts