Individual provider Active NPI

Laura Costa, PH.D.

  • Clinical Psychologist
  • Baltimore, MD
National Provider Identifier
1659685840
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
04810 Issued in MD
Practice address
707 N. Broadway
Baltimore, MD 21205
Phone
(443) 923-9200
Fax
(443) 923-9405
NPI assigned
Jul 30, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 04810 MD Primary

Addresses

Primary practice location

707 N. Broadway
Baltimore, MD 21205

Mailing address

1741 Ashland Ave.
Baltimore, MD 21205
Phone (443) 923-1870

Other names 1

  • Laura Newton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231113002010 MD Practitioner - Clinical Psychologist 0648627604 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
04810MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Krieger Associates CurrentSince Sep 26, 2023 Accepting new patients
Kennedy Krieger Associates CurrentSince Sep 26, 2023 Accepting new patients

Locations

1741 Ashland Ave
Baltimore, MD 21205
Phone (443) 923-1842

1741 Ashland Ave
Rm 646
Baltimore, MD 21205
Phone (443) 923-1842

2931 E Biddle St
Baltimore, MD 21213
Phone (443) 923-1872

707 N Broadway
Baltimore, MD 21205
Phone (443) 923-1870

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1280448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1659685840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1741 ASHLAND AVE.",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21205",
            "telephone_number": "443-923-1870",
            "fax_number": "443-923-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N. BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21205",
            "telephone_number": "443-923-9200",
            "fax_number": "443-923-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTA",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-30",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "04810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "NEWTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.