Provider Demographics
NPI:1518378272
Name:COSTELLO, LAURIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 VALLEYWAY DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-5490
Mailing Address - Country:US
Mailing Address - Phone:407-408-4722
Mailing Address - Fax:
Practice Address - Street 1:751 VALLEYWAY DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5490
Practice Address - Country:US
Practice Address - Phone:407-408-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator