Provider Demographics
NPI:1558703215
Name:COSTA-MINCH, AILYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AILYN
Middle Name:
Last Name:COSTA-MINCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MARY ANN LN
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3138
Mailing Address - Country:US
Mailing Address - Phone:201-421-8789
Mailing Address - Fax:
Practice Address - Street 1:390 HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2759
Practice Address - Country:US
Practice Address - Phone:201-421-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055091001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical