| Doctor Name: | MICAELA COSTA |
| NPI Number: | 1023317237 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | CSW01252 |
| Business Practice Address: | 940 Belmont St Brockton, MA - 023015596 |
| Business Phone Number: | 7748263321 |
| Business Fax Number: | |
| Mailing Address: | 200 High Service Ave, NORTH PROVIDENCE |
| State: | RI |
| Postal Code: | 029045113 |
| Phone Number: | 4014563100 |
| Fax Number: | |
| NPI Enumeration Date: | 03/28/2011 |
| NPI Last Update Date: | 12/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CSW01252 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |