MEDICARE: JAIME ACOSTA L.C.S.W.

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	SW4892	FL

General Provider Information

NPI Number	:	1316960800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME ACOSTA L.C.S.W.

Provider Business Mailing Address
First Line	:	253 NE 2ND ST APT 1704
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-2292
Country	:	US
Telephone Number	:	786-525-7470
Fax Number	:	786-796-5253

Provider Business Practice Location Address
First Line	:	253 NE 2ND ST APT 1704
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-2292
Country	:	US
Telephone Number	:	786-525-7470
Fax Number	:	786-796-5253

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	09/23/2024

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