Provider Demographics
NPI:1548225691
Name:COSTELLO, CHRISTOPHER RICHARD (LICSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RICHARD
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 HAVERHILL RD
Mailing Address - Street 2:STE 359
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-388-0800
Mailing Address - Fax:978-388-7778
Practice Address - Street 1:110 HAVERHILL RD
Practice Address - Street 2:STE 359
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2123
Practice Address - Country:US
Practice Address - Phone:978-388-0800
Practice Address - Fax:978-388-7778
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22278Medicare ID - Type Unspecified