Provider Demographics
NPI:1215074166
Name:COSTA, GERALDINE A (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:A
Last Name:COSTA
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 1:300 MERCER ST
Mailing Address - Street 2:SUITE # 11E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6724
Mailing Address - Country:US
Mailing Address - Phone:212-777-4885
Mailing Address - Fax:212-473-1010
Practice Address - Street 1:300 MERCER ST
Practice Address - Street 2:SUITE # 11E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6724
Practice Address - Country:US
Practice Address - Phone:212-777-4885
Practice Address - Fax:212-473-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR 011883-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP623964OtherOXFORD HEALTH PLAN
NY82189OtherGHI
NY145973OtherVALUE OPTIONS
NYN07481Medicare ID - Type Unspecified