Healthcare Provider Details

I. General information

NPI: 1235927104
Provider Name (Legal Business Name): DEBRA RENAE DACOSTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

779 11TH AVE APT 4D
PATERSON NJ
07514-1033
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-4000
  • Fax:
Mailing address:
  • Phone: 973-870-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06341600
License Number StateNJ

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: