MEDICARE: MARISA ACOSTA

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1184588444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA ACOSTA

Provider Business Mailing Address
First Line	:	4004 GLOSTER WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-2038
Country	:	US
Telephone Number	:	916-928-5316
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 GLOSTER WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-2038
Country	:	US
Telephone Number	:	916-928-5316
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “ MARISA ACOSTA ” Practice Location

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