MEDICARE: JESSICA COSTANTINO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1225848740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA COSTANTINO

Provider Business Mailing Address
First Line	:	1100 CORNWALL RD
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2410
Country	:	US
Telephone Number	:	732-605-6353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 CORNWALL RD
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2410
Country	:	US
Telephone Number	:	732-605-6353
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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