Provider Demographics
NPI:1518257179
Name:COSTELLO, CORRINE A
Entity Type:Individual
Prefix:MS
First Name:CORRINE
Middle Name:A
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OCEAN PINES DR
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-2300
Mailing Address - Country:US
Mailing Address - Phone:508-888-7828
Mailing Address - Fax:
Practice Address - Street 1:26 OCEAN PINES DR
Practice Address - Street 2:
Practice Address - City:SAGAMORE BEACH
Practice Address - State:MA
Practice Address - Zip Code:02562-2300
Practice Address - Country:US
Practice Address - Phone:508-888-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor