Provider Demographics
NPI:1043937733
Name:ACOSTA, GEMA
Entity type:Individual
Prefix:
First Name:GEMA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5042
Mailing Address - Country:US
Mailing Address - Phone:786-393-3484
Mailing Address - Fax:
Practice Address - Street 1:2800 WESTON RD STE 100
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3638
Practice Address - Country:US
Practice Address - Phone:786-505-4449
Practice Address - Fax:786-667-3733
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-77782103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst