=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316960800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIME ACOSTA L.C.S.W.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 253 NE 2ND ST APT 1704
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33132-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-525-7470
-----------------------------------------------------
Fax | 786-796-5253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 NE 2ND ST APT 1704
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33132-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-525-7470
-----------------------------------------------------
Fax | 786-796-5253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW4892
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------