Basic Information
| Provider Information | |||||||||
| NPI: | 1336664580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACOSTA | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | JEANNIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1922 DALY AVE APT 2 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104604341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477127933 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1894 WALTON AVE # 10453 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104536018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185833060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2017 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 0183004 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.