Provider Demographics
NPI:1992488951
Name:COSTA, KATHERINE M
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:COSTA
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 1:4039 S ATHOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9643
Mailing Address - Country:US
Mailing Address - Phone:978-696-1984
Mailing Address - Fax:
Practice Address - Street 1:155 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8142
Practice Address - Country:US
Practice Address - Phone:978-343-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)