Provider Demographics
NPI:1811460413
Name:ACOSTA, ESPERANZA
Entity type:Individual
Prefix:MS
First Name:ESPERANZA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W 49TH ST STE 406
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3489
Mailing Address - Country:US
Mailing Address - Phone:305-587-2231
Mailing Address - Fax:305-713-1866
Practice Address - Street 1:900 W 49TH ST STE 406
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3489
Practice Address - Country:US
Practice Address - Phone:305-587-2231
Practice Address - Fax:305-713-1866
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100160900Medicaid