Provider Demographics
NPI:1639102767
Name:ACOSTA, RAFAELINA MERCEDES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RAFAELINA
Middle Name:MERCEDES
Last Name:ACOSTA
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 1:8 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1202
Mailing Address - Country:US
Mailing Address - Phone:845-461-0939
Mailing Address - Fax:845-575-5004
Practice Address - Street 1:978 ROUTE 45 STE 100
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3512
Practice Address - Country:US
Practice Address - Phone:845-461-0939
Practice Address - Fax:845-575-5004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0710211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1062740OtherBEACON HEALTH STRATEGIES