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NPI Code Detail

MEDICARE: ANDRES ACOSTA LCSW

MEDICARE: ANDRES ACOSTA LCSW
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
1101YM0800XMental Health Counselor149007194IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1149007194OTHERILLCSW

General Provider Information

NPI Number : 1891881843
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRES ACOSTA LCSW
Provider Business Mailing Address
First Line : 1644 W COLONIAL PKWY
Second Line :
City : INVERNESS
State : IL
Zip : 60067-1207
Country : US
Telephone Number : 847-776-4500
Fax Number : 847-776-4724
Provider Business Practice Location Address
First Line : 1644 W COLONIAL PKWY
Second Line :
City : INVERNESS
State : IL
Zip : 60067-1207
Country : US
Telephone Number : 847-776-4500
Fax Number : 847-776-4724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 10/08/2009

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Directions to “ ANDRES ACOSTA LCSW” Practice Location

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