Provider Demographics
NPI:1336878933
Name:DACOSTA, BETH-ANNE ELAN
Entity type:Individual
Prefix:
First Name:BETH-ANNE
Middle Name:ELAN
Last Name:DACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2174 N 72ND TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1042
Mailing Address - Country:US
Mailing Address - Phone:954-296-9085
Mailing Address - Fax:
Practice Address - Street 1:2174 N 72ND TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-1042
Practice Address - Country:US
Practice Address - Phone:954-296-9085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst