Basic Information
| Provider Information | |||||||||
| NPI: | 1437558871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACOSTA | ||||||||
| FirstName: | SARAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22790 SW 112TH AVE STE 501 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331707602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0532352616 | ||||||||
| FaxNumber: | 3052356178 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 NW 79TH AVE | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331666556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055973861 | ||||||||
| FaxNumber: | 3055973863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2014 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH21408 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.