Provider Demographics
NPI:1295037554
Name:ACOSTA, JOLENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28700 N. BONQUET CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-0003
Mailing Address - Country:US
Mailing Address - Phone:661-296-8500
Mailing Address - Fax:661-296-7946
Practice Address - Street 1:28700 N. BONQUET CANYON ROAD
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350-0003
Practice Address - Country:US
Practice Address - Phone:661-296-8500
Practice Address - Fax:661-296-7946
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist