Healthcare Provider Details

I. General information

NPI: 1689871923
Provider Name (Legal Business Name): YARA R. COSTA PSYD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/03/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LAKE COOK RD
DEERFIELD IL
60015-5646
US

IV. Provider business mailing address

1500 SOUTH FAIRFIELD OFFICE #NR-260
CHICAGO IL
60608-1782
US

V. Phone/Fax

Practice location:
  • Phone: 847-343-5554
  • Fax:
Mailing address:
  • Phone: 847-343-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number071009332
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: