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NPI Code Detail

MEDICARE: LISBETH JEANNE COSTA LICSW

MEDICARE: LISBETH JEANNE COSTA LICSW
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
1101YM0800XMental Health Counselor111036MA

General Provider Information

NPI Number : 1497763924
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISBETH JEANNE COSTA LICSW
Provider Business Mailing Address
First Line : 4 LINWOOD AVENUE
Second Line :
City : ROCKPORT
State : MA
Zip : 01966
Country : US
Telephone Number : 978-546-3113
Fax Number :
Provider Business Practice Location Address
First Line : 4 LINWOOD AVENUE
Second Line :
City : ROCKPORT
State : MA
Zip : 01966
Country : US
Telephone Number : 978-546-3113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/08/2007

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Directions to “ LISBETH JEANNE COSTA LICSW” Practice Location

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