Healthcare Provider Details

I. General information

NPI: 1003467663
Provider Name (Legal Business Name): GIBELLE NOELIA ACOSTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 60TH ST RM 704
NEW YORK NY
10022-1799
US

IV. Provider business mailing address

110 E 60TH ST RM 704
NEW YORK NY
10022-1799
US

V. Phone/Fax

Practice location:
  • Phone: 631-323-6546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: