Provider Demographics
NPI:1629393228
Name:KOSTYK, MARIA (LMHC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KOSTYK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ECHO AVE
Mailing Address - Street 2:HILL HOUSE
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2417
Mailing Address - Country:US
Mailing Address - Phone:978-524-0175
Mailing Address - Fax:
Practice Address - Street 1:6 ECHO AVE
Practice Address - Street 2:HILL HOUSE
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2417
Practice Address - Country:US
Practice Address - Phone:978-524-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health