Provider Demographics
NPI:1013979392
Name:COSTA, DAVID (LMHC LMFT LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COSTA
Suffix:
Gender:M
Credentials:LMHC LMFT LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SPRING ST
Mailing Address - Street 2:STE 109
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-996-1280
Mailing Address - Fax:
Practice Address - Street 1:106 SPRING ST
Practice Address - Street 2:STE 109
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-678-0041
Practice Address - Fax:508-324-9002
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103101Y00000X
MA202045104100000X
MA129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA103OtherLMHC LICENSE
MA129OtherLMFT LICENSE
MA202045OtherLCSW LICENSE