Provider Demographics
NPI:1245495217
Name:ACOSTA, LETICIA (MA)
Entity type:Individual
Prefix:MISS
First Name:LETICIA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 TELEGRAPH RD
Mailing Address - Street 2:BLDG. G
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3675
Mailing Address - Country:US
Mailing Address - Phone:562-942-8256
Mailing Address - Fax:562-942-8256
Practice Address - Street 1:11731 TELEGRAPH RD
Practice Address - Street 2:BLDG. G
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3675
Practice Address - Country:US
Practice Address - Phone:562-942-8256
Practice Address - Fax:562-942-8256
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62792OtherMFT INTERN NO