MEDICARE: STEPHANIE COSTA 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
1	1041C0700X	Clinical Social Worker	102192	NY

General Provider Information

NPI Number	:	1174396238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE COSTA LCSW

Provider Business Mailing Address
First Line	:	2542 WANTAGH AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4440
Country	:	US
Telephone Number	:	516-413-5949
Fax Number	:

Provider Business Practice Location Address
First Line	:	2542 WANTAGH AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4440
Country	:	US
Telephone Number	:	516-413-5949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	03/08/2026

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Directions to “ STEPHANIE COSTA LCSW” Practice Location

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