Provider Demographics
NPI:1831289180
Name:COSTELLO, CAROL ANNE
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:ANNE
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 1:23 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:N WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191-2209
Mailing Address - Country:US
Mailing Address - Phone:781-910-7183
Mailing Address - Fax:
Practice Address - Street 1:500 VICTORY RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-3139
Practice Address - Country:US
Practice Address - Phone:617-774-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health