MEDICARE: DANIELLE ROSE COSTABILE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1912760281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ROSE COSTABILE MA

Provider Business Mailing Address
First Line	:	510 WILKINS GLEN RD
Second Line	:
City	:	MEDFIELD
State	:	MA
Zip	:	02052-2032
Country	:	US
Telephone Number	:	339-221-1788
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 FORBES RD STE 2204
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2705
Country	:	US
Telephone Number	:	781-570-3530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

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Directions to “ DANIELLE ROSE COSTABILE MA” Practice Location

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