Provider Demographics
NPI:1497763924
Name:COSTA, LISBETH JEANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:JEANNE
Last Name:COSTA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LINWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966
Mailing Address - Country:US
Mailing Address - Phone:978-546-3113
Mailing Address - Fax:
Practice Address - Street 1:4 LINWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966
Practice Address - Country:US
Practice Address - Phone:978-546-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health