Individual
ANTONIO DACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4620 N 16TH ST, SUITE #E-110, PHOENIX, AZ 85016-5121
(602) 264-2770
(866) 534-1701
Mailing address
4620 N 16TH ST, SUITE #E-110, PHOENIX, AZ 85016-5121
(602) 264-2770
(866) 534-1701
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW01941
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW-0194
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
721002
—
AZ
Enumeration date
04/25/2007
Last updated
03/28/2008
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