Provider Demographics
NPI:1861239428
Name:DELLA COSTA, MICHELE DIANA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANA
Last Name:DELLA COSTA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 37TH STREET CT W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2268
Mailing Address - Country:US
Mailing Address - Phone:941-504-3316
Mailing Address - Fax:
Practice Address - Street 1:1415 37TH STREET CT W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2268
Practice Address - Country:US
Practice Address - Phone:941-504-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist