Healthcare Provider Details

I. General information

NPI: 1245509561
Provider Name (Legal Business Name): SUSAN ACOSTA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 SW 62ND AVE STE 200
SOUTH MIAMI FL
33143-4923
US

IV. Provider business mailing address

8512 SW 169TH TER
PALMETTO BAY FL
33157-4646
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-6363
  • Fax:
Mailing address:
  • Phone: 305-298-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: