Active NPI
Angela Monceaux Costilla, LCSW
- Clinical Social Worker
- Lafayette, LA
National Provider Identifier
1194801555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4565
- Practice address
- 302 Dulles Dr
Lafayette, LA 70506-3008 - Phone
- (337) 262-4100
- NPI assigned
- Oct 28, 2006
- Reactivated
- Feb 17, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4565 | LA | Primary |
Addresses
Primary practice location
302 Dulles Dr
Lafayette, LA 70506-3008
Mailing address
2851 Johnston St # 549
Lafayette, LA 70503-3243
Phone (337) 356-7924
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4565 | LA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424822400000",
"number": "1194801555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2851 JOHNSTON ST # 549",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705033243",
"telephone_number": "337-356-7924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 DULLES DR",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705063008",
"telephone_number": "337-262-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTILLA",
"first_name": "ANGELA",
"middle_name": "MONCEAUX",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-28",
"last_updated": "2015-02-25",
"deactivation_date": "2011-12-28",
"reactivation_date": "2015-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "4565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
- Cassandra Julie Cosby
- Costco Wholesale Corporation
- Costco Wholesale Corporation
- Costco Wholesale Corporation
- Robert Vance Costello, DDS
- Counseling and Psychiatric Associates, LLC
- Counseling and Psychotherapy Group, Inc.
- Counseling and Recovery Guidance
- Counseling Associates, LLC
- Kaitlyn Coupel, PLPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.