Provider Demographics
NPI:1871882134
Name:ACOSTA, SHIRLEY ASELLI (BS)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ASELLI
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WOODLANE RD.
Mailing Address - Street 2:
Mailing Address - City:MT. HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2053
Mailing Address - Country:US
Mailing Address - Phone:856-428-1300
Mailing Address - Fax:
Practice Address - Street 1:770 WOODLANE RD.
Practice Address - Street 2:
Practice Address - City:MT. HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2504
Practice Address - Country:US
Practice Address - Phone:856-428-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health