Provider Demographics
NPI:1831811942
Name:COSTELLO, PHOEBE (MSW)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-4465
Mailing Address - Country:US
Mailing Address - Phone:203-444-4692
Mailing Address - Fax:
Practice Address - Street 1:410 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5014
Practice Address - Country:US
Practice Address - Phone:203-444-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker