Healthcare Provider Details

I. General information

NPI: 1649989666
Provider Name (Legal Business Name): KIANA COSTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TOLL GATE RD STE 103
WARWICK RI
02886-4440
US

IV. Provider business mailing address

182 GROVE AVE APT 2
EAST PROVIDENCE RI
02914-3747
US

V. Phone/Fax

Practice location:
  • Phone: 401-477-9446
  • Fax:
Mailing address:
  • Phone: 401-919-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: