Provider Demographics
NPI:1386973626
Name:CAROL A. COSTELLO, LMHC, LMFT, LLC
Entity type:Organization
Organization Name:CAROL A. COSTELLO, LMHC, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC, LMFT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LMFT
Authorized Official - Phone:781-337-6200
Mailing Address - Street 1:61 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-3367
Mailing Address - Country:US
Mailing Address - Phone:781-337-6200
Mailing Address - Fax:781-337-6222
Practice Address - Street 1:61 WINTER ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-3367
Practice Address - Country:US
Practice Address - Phone:781-337-6200
Practice Address - Fax:781-337-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1831289180OtherNPI