Provider Demographics
NPI:1992050900
Name:COSTANZO, JOSEPHINE (LPC)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:COSTANZO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CALVIN PLACE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2450
Mailing Address - Country:US
Mailing Address - Phone:732-549-0401
Mailing Address - Fax:732-549-4446
Practice Address - Street 1:15 CALVIN PLACE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2450
Practice Address - Country:US
Practice Address - Phone:732-549-0401
Practice Address - Fax:732-549-4446
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00456200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional