Jennifer L. De Costa, PHD, MFT, CSAC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT272 Issued in HI

Practice address

75-5751 Kuakini Hwy
Suite 105
Kailua Kona, HI 96740-1752

Phone

(808) 326-5629

Fax

(808) 329-5057

NPI assigned

Oct 28, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302048000000",
    "number": "1063665529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5751 KUAKINI HWY",
            "address_2": "SUITE 105",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401752",
            "telephone_number": "808-326-5629",
            "fax_number": "808-329-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5751 KUAKINI HWY",
            "address_2": "SUITE 105",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401752",
            "telephone_number": "808-326-5629",
            "fax_number": "808-329-5057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE COSTA",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PHD, MFT, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-28",
        "last_updated": "2011-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "MFT272",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "HI",
            "license": "1249-05",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSAC",
            "identifier": "1249-05",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MFT",
            "identifier": "MFT272",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Kwon Jr DDS
• Emily Elise David
• Amy Lanelle Davis, P.T.
• Amy Leah Davis, M.ED.
• Dana Davis, LMT
• Daniel Aaron Debiec, LPC
• Kevin Deeds, SAC
• Jessica Dehmel
• Gabrielle Dela Cruz
• Daisy Delangen, L.AC.

• All providers in Kailua Kona, HI
• Marriage & Family Therapist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.