Provider Demographics
NPI:1255817722
Name:COSTELLO, HELEN ELEANOR (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:ELEANOR
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 MOUSE LN
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3626
Mailing Address - Country:US
Mailing Address - Phone:603-344-5639
Mailing Address - Fax:
Practice Address - Street 1:477 MOUSE LN
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:ME
Practice Address - Zip Code:04002-3626
Practice Address - Country:US
Practice Address - Phone:603-344-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered