Provider Demographics
NPI:1972965606
Name:COSTELLO, CHAD M (LCSW)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:M
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KNOLLCROFT RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NJ
Mailing Address - Zip Code:07939-5001
Mailing Address - Country:US
Mailing Address - Phone:908-647-0180
Mailing Address - Fax:
Practice Address - Street 1:151 KNOLLCROFT RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058115001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical