Provider Demographics
NPI:1831759091
Name:COSTELLO, CARRIE A
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GERRIOR DR
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03290-5905
Mailing Address - Country:US
Mailing Address - Phone:978-804-2657
Mailing Address - Fax:
Practice Address - Street 1:5 GERRIOR DR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:NH
Practice Address - Zip Code:03290-5905
Practice Address - Country:US
Practice Address - Phone:978-804-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical