Provider Demographics
NPI:1164847398
Name:ACOSTA, HENRY (MA, MSW, LSW)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MA, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3411
Mailing Address - Country:US
Mailing Address - Phone:973-930-1844
Mailing Address - Fax:
Practice Address - Street 1:553 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3411
Practice Address - Country:US
Practice Address - Phone:973-930-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL00226200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker