Provider Demographics
NPI:1922581206
Name:COSTA, ESTHER ODEMARIES
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:ODEMARIES
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:CARRETERA 877 KM 1.6 CAMINO LAS LOMAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-625-2900
Mailing Address - Fax:787-760-0125
Practice Address - Street 1:549 CALLE DEL MAR
Practice Address - Street 2:GALERIA NORTE SUITE 301
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-878-1471
Practice Address - Fax:787-880-4555
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3210103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist