Provider Demographics
NPI:1356437602
Name:COSTA, MAUREEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 WAGON WHEEL CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9128
Mailing Address - Country:US
Mailing Address - Phone:732-625-1325
Mailing Address - Fax:732-886-7076
Practice Address - Street 1:71 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2138
Practice Address - Country:US
Practice Address - Phone:732-625-1325
Practice Address - Fax:732-886-7076
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051999001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical