Provider Demographics
NPI:1942361019
Name:COSTA, NICOLE LEIGH (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEIGH
Last Name:COSTA
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WATER ST
Mailing Address - Street 2:HOPE BY THE SEA
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3977
Mailing Address - Country:US
Mailing Address - Phone:508-982-6092
Mailing Address - Fax:
Practice Address - Street 1:170 WATER ST
Practice Address - Street 2:HOPE BY THE SEA
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3977
Practice Address - Country:US
Practice Address - Phone:508-982-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical