Basic Information
| Provider Information | |||||||||
| NPI: | 1275544793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PSY D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 POYDRAS ST | ||||||||
| Address2: | SUITE 1640 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701121221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121835 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3450 CHESTNUT ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701152443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 946 | LA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.