Provider Demographics
NPI:1740085869
Name:DACOSTA, VICTORIA E (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:DACOSTA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 N 22ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4639
Mailing Address - Country:US
Mailing Address - Phone:602-989-8759
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4639
Practice Address - Country:US
Practice Address - Phone:602-989-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-220171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical