Healthcare Provider Details

I. General information

NPI: 1225361207
Provider Name (Legal Business Name): BARBARA COSTELLO BMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9741 CANDELARIA RD NE
ALBUQUERQUE NM
87112-1401
US

IV. Provider business mailing address

2760 PANORAMA HEIGHTS DR SE
RIO RANCHO NM
87124-3935
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-3624
  • Fax:
Mailing address:
  • Phone: 575-770-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0796
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: