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General NPI Number Information
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NPI Number | 1134749161
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Entity Type | Individual
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Provider Name | MARGO MARIE COSTELLO BSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 04/20/2020
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Last Update Date | 04/20/2020
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Provider Practice Location Address
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Address Line | 311 MARTIN LUTHER KING DR E
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City | CINCINNATI
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State | OH
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Zip | 45219-2581
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Country | US
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Telephone | 513-332-0354
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Fax |
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Provider Business Mailing Address
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Address Line | 6234 LILBUR LN
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City | CINCINNATI
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State | OH
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Zip | 45230-3734
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Country | US
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Telephone | 513-477-2555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2004674
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License Number State | OH
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