MEDICARE: CAROL A. COSTELLO, LMHC, LMFT, LLC

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	101YM0800X	Mental Health Counselor	6230	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1831289180	OTHER	MA	NPI

General Provider Information

NPI Number	:	1386973626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL A. COSTELLO, LMHC, LMFT, LLC

Provider Business Mailing Address
First Line	:	61 WINTER ST
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02188-3367
Country	:	US
Telephone Number	:	781-337-6200
Fax Number	:	781-337-6222

Provider Business Practice Location Address
First Line	:	61 WINTER ST
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02188-3367
Country	:	US
Telephone Number	:	781-337-6200
Fax Number	:	781-337-6222

Authorized Official
Title or Position	:	LMHC, LMFT
Name	:	MISS CAROL A. COSTELLO
Credential	:	LMHC, LMFT
Telephone Number	:	781-337-6200

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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