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NPI Code Detail

MEDICARE: MS. MELISSA GRACE COSTA LMSW

MEDICARE: MS. MELISSA GRACE COSTA LMSW
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
1104100000XSocial Worker11320301NY

General Provider Information

NPI Number : 1548620008
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELISSA GRACE COSTA LMSW
Provider Business Mailing Address
First Line : 1065 SOUTHERN BLVD
Second Line :
City : BRONX
State : NY
Zip : 10459-2417
Country : US
Telephone Number : 914-329-9937
Fax Number :
Provider Business Practice Location Address
First Line : 1065 SOUTHERN BLVD
Second Line :
City : BRONX
State : NY
Zip : 10459-2417
Country : US
Telephone Number : 914-329-9937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2016
Last Update Date : 12/08/2025

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Directions to “ MS. MELISSA GRACE COSTA LMSW” Practice Location

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