Provider Demographics
NPI:1194909747
Name:COSTELLO, CHRISTINE (LCSW, LCADC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 BRIDGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4544
Mailing Address - Country:US
Mailing Address - Phone:732-892-0082
Mailing Address - Fax:732-892-1616
Practice Address - Street 1:703 BRIDGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4544
Practice Address - Country:US
Practice Address - Phone:732-892-0082
Practice Address - Fax:732-892-1616
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC039061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical