Basic Information
| Provider Information | |||||||||
| NPI: | 1689854515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACOSTA | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2211 CHARLOTTE ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164045810 | ||||||||
| FaxNumber: | 8164045845 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 CHARLOTTE ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164045810 | ||||||||
| FaxNumber: | 8164045845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 11/08/2007 | ||||||||
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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 | 1041C0700X | 2007027436 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6834 | 01 | KS | LICENSED MASTERS IN SOCIA | OTHER | 1847 | 01 | NE | LICENSED MENTAL HEALTH PR | OTHER | 189 | 01 | NE | CERTIFIED MASTER SOCIAL W | OTHER | 2007027436 | 01 | MO | LICENSED CLINICAL SOCIAL | OTHER |