Healthcare Provider Details

I. General information

NPI: 1073005773
Provider Name (Legal Business Name): DR. BRIAN DACOSTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 E CHOCOLATE AVE
HERSHEY PA
17033-1216
US

IV. Provider business mailing address

825 EDEN RD
LANCASTER PA
17601-4713
US

V. Phone/Fax

Practice location:
  • Phone: 717-462-7003
  • Fax:
Mailing address:
  • Phone: 717-462-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020740
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: