Provider Demographics
NPI:1538397526
Name:DECOSTA, LOUISE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:
Last Name:DECOSTA
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 IRVING PLACE
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2325
Mailing Address - Country:US
Mailing Address - Phone:212-533-6406
Mailing Address - Fax:
Practice Address - Street 1:61 IRVING PLACE
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2325
Practice Address - Country:US
Practice Address - Phone:212-533-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020674-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical