Provider Demographics
NPI:1720551583
Name:ACOSTA, CHRISTINA JANETH
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JANETH
Last Name:ACOSTA
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 1:858 HUNTINGTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6200
Mailing Address - Country:US
Mailing Address - Phone:603-714-2455
Mailing Address - Fax:
Practice Address - Street 1:858 HUNTINGTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6200
Practice Address - Country:US
Practice Address - Phone:603-714-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician