Basic Information
| Provider Information | |||||||||
| NPI: | 1467784520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | GABRIELLA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112378042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474748464 | ||||||||
| FaxNumber: | 3476300519 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112378042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474748464 | ||||||||
| FaxNumber: | 3476300519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2010 | ||||||||
| LastUpdateDate: | 11/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 077856 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.