Provider Demographics
NPI:1649989666
Name:COSTA, KIANA (LCSW)
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 GROVE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3747
Mailing Address - Country:US
Mailing Address - Phone:401-919-7353
Mailing Address - Fax:
Practice Address - Street 1:200 TOLL GATE RD STE 103
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4440
Practice Address - Country:US
Practice Address - Phone:401-477-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICSW02849OtherLCSW