Provider Demographics
NPI:1154458529
Name:COSTA, MICHELLE CLAIRE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CLAIRE
Last Name:COSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 PARKAIRE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2321
Mailing Address - Country:US
Mailing Address - Phone:504-220-2525
Mailing Address - Fax:504-885-6974
Practice Address - Street 1:4113 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2202
Practice Address - Country:US
Practice Address - Phone:504-464-1021
Practice Address - Fax:504-464-1022
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H387Medicare ID - Type Unspecified