Provider Demographics
NPI:1134749161
Name:COSTELLO, MARGO MARIE (BSW, LSW)
Entity type:Individual
Prefix:MISS
First Name:MARGO
Middle Name:MARIE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:BSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 LILBUR LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-3734
Mailing Address - Country:US
Mailing Address - Phone:513-477-2555
Mailing Address - Fax:
Practice Address - Street 1:311 MARTIN LUTHER KING DR E
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2581
Practice Address - Country:US
Practice Address - Phone:513-332-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2004674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker