Provider Demographics
NPI:1063786564
Name:COSTELLO, JENNIFER E
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
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 1:34539 PACK LN
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3304
Mailing Address - Country:US
Mailing Address - Phone:302-841-4503
Mailing Address - Fax:
Practice Address - Street 1:306 UNION ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1622
Practice Address - Country:US
Practice Address - Phone:301-304-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)