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General NPI Number Information
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NPI Number | 1841458775
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Entity Type | Individual
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Provider Name | DAIANA DACOSTA MS, LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 132 GREAT RD STE 200
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City | STOW
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State | MA
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Zip | 01775
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Country | US
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Telephone | 978-263-0439
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Fax |
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Provider Business Mailing Address
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Address Line | 41 BOSTON RD UNIT 123
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City | NORTH BILLERICA
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State | MA
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Zip | 01862-1040
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Country | US
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Telephone | 954-803-1906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMT1111
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License Number State | FL
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