Provider Demographics
NPI:1386774248
Name:WHITE, JUDITH COSTELLA (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:COSTELLA
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:COSTELLA
Other - Last Name:BEYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 RIVERSIDE DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1801
Mailing Address - Country:US
Mailing Address - Phone:212-864-7212
Mailing Address - Fax:
Practice Address - Street 1:27 W 86TH ST # 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3615
Practice Address - Country:US
Practice Address - Phone:212-864-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00801111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N18261Medicare ID - Type Unspecified