Individual
MRS. MICHAELLA D COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 NEWMAN AVE, RUMFORD, RI 02916-1218
(401) 349-2911
Mailing address
225 NEWMAN AVE, RUMFORD, RI 02916-1218
(401) 349-2911
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01242
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30706-2
BLUE CROSS
RI
01
—
406292
BLUE CHIP
RI
01
—
62-95447
UNITED BEHAVIORAL HEALTH
RI
05
—
MM29078
—
RI
Enumeration date
07/04/2006
Last updated
07/08/2007
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