Provider Demographics
NPI:1316960800
Name:ACOSTA, JAIME (LCSW)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 NE 2ND ST APT 1704
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2292
Mailing Address - Country:US
Mailing Address - Phone:786-525-7470
Mailing Address - Fax:786-796-5253
Practice Address - Street 1:253 NE 2ND ST APT 1704
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2292
Practice Address - Country:US
Practice Address - Phone:786-525-7470
Practice Address - Fax:786-796-5253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW48921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1835BMedicare ID - Type UnspecifiedPROVIDER NUMBER