Provider Demographics
NPI:1811372592
Name:ACOSTA, SILVIA LAURA (LCSW)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:LAURA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 BROADWAY STE 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5403
Mailing Address - Country:US
Mailing Address - Phone:224-585-9690
Mailing Address - Fax:
Practice Address - Street 1:1182 BROADWAY STE 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5403
Practice Address - Country:US
Practice Address - Phone:224-585-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490184411041C0700X
NJ44SC058280001041C0700X
NY08764011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical