Provider Demographics
NPI:1992393300
Name:DECOSTA, ALEXANDRA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:DECOSTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 GOLDSMITH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2239
Mailing Address - Country:US
Mailing Address - Phone:401-301-7680
Mailing Address - Fax:
Practice Address - Street 1:154 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4368
Practice Address - Country:US
Practice Address - Phone:508-925-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty