1013979392 NPI number — DAVID COSTA LMHC LMFT LCSW

Table of content: DAVID COSTA LMHC LMFT LCSW (NPI 1013979392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013979392 NPI number — DAVID COSTA LMHC LMFT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTA
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC LMFT LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013979392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 SPRING ST
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
NEW BEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-996-1280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 SPRING ST
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-678-0041
Provider Business Practice Location Address Fax Number:
508-324-9002
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  103 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: 202045 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 129 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103 . This is a "LMHC LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 129 . This is a "LMFT LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 202045 . This is a "LCSW LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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