Provider Demographics
NPI:1659685840
Name:COSTA, LAURA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1741 ASHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205
Mailing Address - Country:US
Mailing Address - Phone:443-923-1870
Mailing Address - Fax:443-923-1895
Practice Address - Street 1:707 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:443-923-9200
Practice Address - Fax:443-923-9405
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical