Provider Demographics
NPI:1508011271
Name:COSTELLO, AILEEN BEAUCHAMP (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:BEAUCHAMP
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIDGE PIKE
Mailing Address - Street 2:#B-10
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1929
Mailing Address - Country:US
Mailing Address - Phone:617-645-7406
Mailing Address - Fax:
Practice Address - Street 1:150 RIDGE PIKE
Practice Address - Street 2:#B-10
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1929
Practice Address - Country:US
Practice Address - Phone:617-645-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126953104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker