Individual provider · NPI-1

Dr. Michael Leonard Costa, Psy.D.

Psychologist, Clinical Child & Adolescent · Astoria, NY

NPI number1205401007
StatusActive
Last updated in NPPESMay 24, 2021

Details

NPI
1205401007
Entity type
Individual (NPI-1)
Name
Dr. Michael Leonard Costa
Credential
Psy.D.
Sex
Male
Sole proprietor
No
Enumeration date
May 24, 2021
Certification date
May 24, 2021
Last updated
May 24, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103TC2200X Psychologist, Clinical Child & Adolescent–NYYes

Practice location

2572 43rd St
Astoria, NY 11103-2509

Phone 516-670-5325

Mailing address

2572 43rd St
Astoria, NY 11103-2509

Phone 516-670-5325

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