MEDICARE: KENDRA COSTA

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	104100000X	Social Worker	121043	MA

General Provider Information

NPI Number	:	1629559745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA COSTA

Provider Business Mailing Address
First Line	:	134 STEPHEN ST APT 3
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02748-1912
Country	:	US
Telephone Number	:	774-319-4699
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 PURCHASE ST UNIT 1
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-6233
Country	:	US
Telephone Number	:	508-997-6300
Fax Number	:	508-997-1222

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

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	08/27/2018

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Directions to “ KENDRA COSTA ” Practice Location

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