Provider Demographics
NPI:1144572785
Name:ACOSTA, ELISA I (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:I
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELISA
Other - Middle Name:I
Other - Last Name:YEGROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:570 LEE ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3053
Mailing Address - Country:US
Mailing Address - Phone:732-442-1666
Mailing Address - Fax:
Practice Address - Street 1:570 LEE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861
Practice Address - Country:US
Practice Address - Phone:732-442-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05812800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker