Healthcare Provider Details

I. General information

NPI: 1225521842
Provider Name (Legal Business Name): ELIZABETH A. KOSTA M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH A. LEBLANC

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MERRIMACK ST
LAWRENCE MA
01843-1788
US

IV. Provider business mailing address

370 MERRIMACK ST
LAWRENCE MA
01843-1788
US

V. Phone/Fax

Practice location:
  • Phone: 978-688-4830
  • Fax:
Mailing address:
  • Phone: 978-620-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: