Provider Demographics
NPI:1386410348
Name:ACOSTA, MARIA FERNANDA (LGSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 13TH ST NW # 7
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2009
Mailing Address - Country:US
Mailing Address - Phone:754-715-2847
Mailing Address - Fax:
Practice Address - Street 1:1200 CLIFTON ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5217
Practice Address - Country:US
Practice Address - Phone:202-673-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
DCLG2000027291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator