Provider Demographics
NPI:1003346602
Name:MARTIN COSTA, LUCIANA
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:
Last Name:MARTIN COSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14220 KENDALE LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3923
Mailing Address - Country:US
Mailing Address - Phone:305-546-3163
Mailing Address - Fax:
Practice Address - Street 1:14220 KENDALE LAKES BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:305-546-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst