Provider Demographics
NPI:1851373336
Name:COSTA, DONNA LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LYNN
Last Name:COSTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MR
Other - First Name:DONNA
Other - Middle Name:LYNN
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:202 PLAYHOUSE COR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2265
Mailing Address - Country:US
Mailing Address - Phone:203-518-5340
Mailing Address - Fax:
Practice Address - Street 1:202 PLAYHOUSE COR
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2265
Practice Address - Country:US
Practice Address - Phone:203-518-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008017939Medicaid
CT004123840Medicaid
CT008031626Medicaid