Provider Demographics
NPI:1699016139
Name:COSTA, LISA A
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:COSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4695 MAILIHUNA RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2051
Mailing Address - Country:US
Mailing Address - Phone:808-821-6957
Mailing Address - Fax:808-821-6958
Practice Address - Street 1:4695 MAILIHUNA RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2051
Practice Address - Country:US
Practice Address - Phone:808-821-6957
Practice Address - Fax:808-821-6958
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker