Provider Demographics
NPI:1811182157
Name:COSTELLO, FRANK III (LCSW)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:COSTELLO
Suffix:III
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 1:17075 DEVONSHIRE STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-923-2270
Mailing Address - Fax:818-368-8940
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-923-2270
Practice Address - Fax:818-368-8940
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CA270841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007473Medicaid