MEDICARE: MS. JAIME COSTELLO MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1306700703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAIME COSTELLO MSW

Provider Business Mailing Address
First Line	:	149 GLENMERE WAY
Second Line	:
City	:	HOLBROOK
State	:	NY
Zip	:	11741-5013
Country	:	US
Telephone Number	:	631-708-9246
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 E MAIN ST
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-3121
Country	:	US
Telephone Number	:	631-286-8282
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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