Dacosta, Andrew

Dacosta, Andrew is an individual health care provider with primary practice located at 12600 Creekside Ln Ste 4 , Fort Myers FL 33919-3353. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Dacosta, Andrew can be contacted via phone (239) 343-9220.

Contact Information

Primary practice address
12600 Creekside Ln Ste 4 Fort Myers FL 33919-3353
Phone: (239) 343-9220
Fax: (239) 343-4240
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X PY12242 Florida
Behavioral Health & Social Service Providers / Psychologist 103T00000X PY12242 Florida

Profile Details

NPI number 1477386118
LBN Legal business name Dacosta, Andrew
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2024
Last updated Apr 24th, 2026 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477386118 NPPES
Florida MEDICAID 125976300

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