MEDICARE: KRISTEN COSTA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	103K00000X	Behavior Analyst
3	222Q00000X	Developmental Therapist
4	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1467740274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN COSTA BCBA

Provider Business Mailing Address
First Line	:	5202 OLDE FOREST DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4160 PIEDMONT PKWY STE 207
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8174
Country	:	US
Telephone Number	:	336-645-6733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	09/30/2025

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Directions to “ KRISTEN COSTA BCBA” Practice Location

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