Individual
ANDREW DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
12600 CREEKSIDE LN STE 4, FORT MYERS, FL 33919-3353
(239) 343-9220
(239) 343-4240
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(393) 439-2202
(239) 343-4240
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY12242
FL
103T00000X
Psychologist
PY12242
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125976300
—
FL
Enumeration date
08/20/2024
Last updated
04/24/2026
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