Provider Demographics
NPI:1093224271
Name:LACOSTA THERAPY, LLC
Entity Type:Organization
Organization Name:LACOSTA THERAPY, LLC
Other - Org Name:THE BEHAVIORISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-860-5161
Mailing Address - Street 1:657 SOUTH DRIVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:786-860-5161
Mailing Address - Fax:
Practice Address - Street 1:657 SOUTH DR STE 403
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5926
Practice Address - Country:US
Practice Address - Phone:786-860-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12872103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty