Provider Demographics
NPI:1952041758
Name:ACOSTA, ANDREW EUGENE
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EUGENE
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 NE 35TH CT
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5815
Mailing Address - Country:US
Mailing Address - Phone:305-989-0555
Mailing Address - Fax:
Practice Address - Street 1:2833 NE 35TH CT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5815
Practice Address - Country:US
Practice Address - Phone:305-989-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst