Provider Demographics
NPI:1760416820
Name:COSTA, RICHARD MANUEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MANUEL
Last Name:COSTA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9845 HORN ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-1981
Mailing Address - Country:US
Mailing Address - Phone:916-361-0440
Mailing Address - Fax:916-361-0404
Practice Address - Street 1:9845 HORN RD
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1992
Practice Address - Country:US
Practice Address - Phone:916-361-0440
Practice Address - Fax:916-361-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 122281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical