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1790140341
IAN DACOSTA
BRONX, NY
NPI
1790140341
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2015-12-28
Last Update Date
2015-12-28
Business Address
-- IAN DACOSTA
3050 WHITE PLAINS ROAD
BRONX, NY 10469
Phone number: 929-348-4486
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Mailing Address
-- IAN DACOSTA
1834 DOGWOOD DRIVE
YORKTOWN HEIGHTS, NY 10598
Phone number: 917-916-7368
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