Provider Demographics
NPI:1205979606
Name:D'COSTA, ESTELLE C (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ESTELLE
Middle Name:C
Last Name:D'COSTA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SPRING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FAR HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07931-2401
Mailing Address - Country:US
Mailing Address - Phone:908-696-8487
Mailing Address - Fax:206-203-2168
Practice Address - Street 1:10 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2343
Practice Address - Country:US
Practice Address - Phone:908-696-8487
Practice Address - Fax:206-203-2168
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003621001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
238856OtherMANAGED HEALTH NETWORK
NJNJ44SC00362100OtherLICENSED CLINICAL SW
0007800150OtherAETNA BEHAVIORAL HEALTH
P2008179OtherOXFORD INSURANCE
NJNJ44SC00362100OtherLICENSED CLINICAL SW