Provider Demographics
NPI:1235321019
Name:KOSTIN, MARIA D
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:KOSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:D
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2238 E GINTER ROAD
Mailing Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706
Mailing Address - Country:US
Mailing Address - Phone:520-545-2137
Mailing Address - Fax:520-545-2120
Practice Address - Street 1:2238 E GINTER ROAD
Practice Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706
Practice Address - Country:US
Practice Address - Phone:520-545-2137
Practice Address - Fax:520-545-2120
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool