Provider Demographics
NPI:1912443375
Name:COSTO, ORLY YVETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ORLY
Middle Name:YVETTE
Last Name:COSTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15218 UNION TPKE APT 10F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3926
Mailing Address - Country:US
Mailing Address - Phone:631-464-2903
Mailing Address - Fax:
Practice Address - Street 1:10470 QUEENS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3694
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:718-275-6062
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087351104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker