Provider Demographics
NPI:1710410683
Name:COSTA, ROBERTA MATOS (LMHC, RPT, MS)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:MATOS
Last Name:COSTA
Suffix:
Gender:F
Credentials:LMHC, RPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5671 OLD BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-8358
Mailing Address - Country:US
Mailing Address - Phone:407-963-4335
Mailing Address - Fax:
Practice Address - Street 1:5671 OLD BERKLEY RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-8358
Practice Address - Country:US
Practice Address - Phone:407-963-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLT3359101YM0800X
FLMH14895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health