Healthcare Provider Details

I. General information

NPI: 1548164031
Provider Name (Legal Business Name): COSTA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 HIGHLAND AVE
SOMERVILLE MA
02143-1537
US

IV. Provider business mailing address

165 MIDDLESEX AVE
SOMERVILLE MA
02145-1105
US

V. Phone/Fax

Practice location:
  • Phone: 617-475-0787
  • Fax:
Mailing address:
  • Phone: 617-475-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEXANDER COSTA
Title or Position: OWNER
Credential: LMHC
Phone: 781-775-0919