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General NPI Number Information
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NPI Number | 1245476738
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Entity Type | Individual
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Provider Name | HOLLY MARIE COSTAR PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 6 STATE ST STE 307A
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City | BANGOR
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State | ME
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Zip | 04401-5133
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Country | US
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Telephone | 207-517-0017
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Fax |
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Provider Business Mailing Address
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Address Line | 236 W BROADWAY
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City | BANGOR
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State | ME
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Zip | 04401-5979
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Country | US
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Telephone | 207-517-0017
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PS1281
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License Number State | ME
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