Provider Demographics
NPI:1245865252
Name:COSMA, AMY MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:COSMA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 BOWER RD
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-9603
Mailing Address - Country:US
Mailing Address - Phone:330-205-1168
Mailing Address - Fax:
Practice Address - Street 1:42 BASSWOOD DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-4912
Practice Address - Country:US
Practice Address - Phone:401-655-2031
Practice Address - Fax:937-606-3077
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186160364SP0808X
OHAPRN.CNP.0028291363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health