Healthcare Provider Details

I. General information

NPI: 1770405672
Provider Name (Legal Business Name): CAROLYN OLIVIA COSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TAUNTON GRN STE 5
TAUNTON MA
02780-3243
US

IV. Provider business mailing address

32 PURCHASE ST APT 1
TAUNTON MA
02780-2682
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-6666
  • Fax:
Mailing address:
  • Phone: 508-828-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: