Provider Demographics
NPI:1740903509
Name:COSTELLO, KAYLA LYNN (MS)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:LYNN
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:LYNN
Other - Last Name:GERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1082 DAVOL ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1124
Mailing Address - Country:US
Mailing Address - Phone:508-678-2833
Mailing Address - Fax:
Practice Address - Street 1:1082 DAVOL ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1124
Practice Address - Country:US
Practice Address - Phone:508-678-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor