Provider Demographics
NPI:1558561480
Name:ACOSTA, ADELA (SW)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JOSE CAMPECHE G17
Mailing Address - Street 2:URB BORINQUEN
Mailing Address - City:CABOROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3372
Mailing Address - Country:US
Mailing Address - Phone:787-226-3380
Mailing Address - Fax:787-899-5141
Practice Address - Street 1:G17 CALLE JOSE CAMPECHE
Practice Address - Street 2:URB BORINQUEN
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3366
Practice Address - Country:US
Practice Address - Phone:787-226-3380
Practice Address - Fax:787-899-5141
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR83921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical