Provider Demographics
NPI:1962843128
Name:COSTA, VICKI (LCSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:COSTA
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 1:800 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-1601
Mailing Address - Country:US
Mailing Address - Phone:302-239-4025
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:808 OLD BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1318
Practice Address - Country:US
Practice Address - Phone:302-239-4025
Practice Address - Fax:410-569-0094
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0000824104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker