Provider Demographics
NPI:1396966222
Name:ACOSTA, INGRID EMILIA (MS)
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:EMILIA
Last Name:ACOSTA
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 1:14343 SW 146TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6794
Mailing Address - Country:US
Mailing Address - Phone:305-252-7594
Mailing Address - Fax:
Practice Address - Street 1:11001 SW 76TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2669
Practice Address - Country:US
Practice Address - Phone:305-598-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health