Provider Demographics
NPI:1326083478
Name:ACOSTA, SHERRY LYNN (PHD, LMHC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6944 COLUMBIA CT
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8006
Mailing Address - Country:US
Mailing Address - Phone:954-304-5699
Mailing Address - Fax:954-372-2069
Practice Address - Street 1:6944 COLUMBIA CT
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-8006
Practice Address - Country:US
Practice Address - Phone:954-304-5699
Practice Address - Fax:954-372-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7605101Y00000X, 101YP2500X, 103K00000X
FLMH 7605101YA0400X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 7605OtherDEPARTMENT OF HEALTH
FL103300500Medicaid