Provider Demographics
NPI:1902230618
Name:COSTELLO, MARIO (LPCC)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 BELLMORE CT
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-6206
Mailing Address - Country:US
Mailing Address - Phone:330-801-5089
Mailing Address - Fax:
Practice Address - Street 1:198 BELLMORE CT
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-6206
Practice Address - Country:US
Practice Address - Phone:330-801-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700198101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10024Medicaid