Healthcare Provider Details

I. General information

NPI: 1437558871
Provider Name (Legal Business Name): SARAH ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE SUITE 501
DORAL FL
33166-6556
US

IV. Provider business mailing address

22790 SW 112TH AVE STE 501
MIAMI FL
33170-7602
US

V. Phone/Fax

Practice location:
  • Phone: 305-597-3861
  • Fax: 305-597-3863
Mailing address:
  • Phone: 53-235-2616
  • Fax: 305-235-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: