Provider Demographics
NPI:1821117169
Name:COSTELLO, DEBORAH (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:KNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:3 ARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4101
Mailing Address - Country:US
Mailing Address - Phone:978-994-3686
Mailing Address - Fax:
Practice Address - Street 1:3 ARLINGTON PL
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4101
Practice Address - Country:US
Practice Address - Phone:978-994-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW169531041C0700X
MA1145181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical