Provider Demographics
NPI:1689262164
Name:COSTA, NANCY (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
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 1:323 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01375-9572
Mailing Address - Country:US
Mailing Address - Phone:413-768-8493
Mailing Address - Fax:
Practice Address - Street 1:323 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MA
Practice Address - Zip Code:01375-9572
Practice Address - Country:US
Practice Address - Phone:413-768-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1057441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical