Healthcare Provider Details

I. General information

NPI: 1790332625
Provider Name (Legal Business Name): SYDNEY MORGAN DACOSTA MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST STE 28
NEEDHAM MA
02494-3133
US

IV. Provider business mailing address

83 ELMIRA ST
BRIGHTON MA
02135-2849
US

V. Phone/Fax

Practice location:
  • Phone: 401-497-1108
  • Fax:
Mailing address:
  • Phone: 401-497-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126116
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: