Provider Demographics
NPI:1366852337
Name:ACOSTA, DOLORES
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BROOME ST APT 6H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4020
Mailing Address - Country:US
Mailing Address - Phone:646-503-9926
Mailing Address - Fax:
Practice Address - Street 1:154 BROOME ST APT 6H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4020
Practice Address - Country:US
Practice Address - Phone:646-503-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator