Provider Demographics
NPI:1972129237
Name:COSTA, LISA J
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
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 1:8 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-1425
Mailing Address - Country:US
Mailing Address - Phone:914-774-3100
Mailing Address - Fax:
Practice Address - Street 1:8 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-1425
Practice Address - Country:US
Practice Address - Phone:914-774-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool