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Individual
MS. KRISTEN LEE COSTA
Active
Individual
MS. KRISTEN LEE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
112239
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
494574
TUFTS
MA
01
—
7009847
AETNA
MA
01
—
PO8602
BLUE CROSS
MA
Enumeration date
02/05/2007
Last updated
07/08/2007
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