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NPI Code Detail

MEDICARE: MRS. ELBA IRIS ACOSTA LCSW

MEDICARE: MRS. ELBA IRIS ACOSTA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC013838NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C013838OTHERNCLCSW LICENSE

General Provider Information

NPI Number : 1114194354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELBA IRIS ACOSTA LCSW
Provider Business Mailing Address
First Line : 301 MCCULLOUGH DR STE 400
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-1336
Country : US
Telephone Number : 980-216-6899
Fax Number : 704-909-2725
Provider Business Practice Location Address
First Line : 301 MCCULLOUGH DR STE 400
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-1336
Country : US
Telephone Number : 980-216-6899
Fax Number : 704-909-2725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2008
Last Update Date : 04/15/2025

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