Provider Demographics
NPI:1902031107
Name:THELMA COSTELLO MS LMHC PC
Entity Type:Organization
Organization Name:THELMA COSTELLO MS LMHC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:518-438-3139
Mailing Address - Street 1:4 EXECUTIVE PARK DR
Mailing Address - Street 2:2ND FLR.
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3718
Mailing Address - Country:US
Mailing Address - Phone:518-438-3139
Mailing Address - Fax:518-207-1900
Practice Address - Street 1:4 EXECUTIVE PARK DR
Practice Address - Street 2:2ND FLR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3718
Practice Address - Country:US
Practice Address - Phone:518-438-3139
Practice Address - Fax:518-207-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000145-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health