Basic Information
| Provider Information | |||||||||
| NPI: | 1538439518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MA, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CHAPEL ST | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112011952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183980153 | ||||||||
| FaxNumber: | 7186232531 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 MONARCH CT | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103144953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172173102 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2012 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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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 | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 005601-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.