MEDICARE: MISS NATALIE ROSE COSTA MA, LMHC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor	005601-1	NY

General Provider Information

NPI Number	:	1538439518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NATALIE ROSE COSTA MA, LMHC

Provider Business Mailing Address
First Line	:	25 CHAPEL ST
Second Line	:	SUITE 901
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1952
Country	:	US
Telephone Number	:	718-398-0153
Fax Number	:	718-623-2531

Provider Business Practice Location Address
First Line	:	44 MONARCH CT
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4953
Country	:	US
Telephone Number	:	917-217-3102
Fax Number	:

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

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	11/20/2019

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