MEDICARE: ELIZABETH J COSTANZA M., ED., C.A.G.S

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	103TS0200X	School Psychologist		MA

General Provider Information

NPI Number	:	1558610972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH J COSTANZA M., ED., C.A.G.S

Provider Business Mailing Address
First Line	:	290 SPRING ST
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-2768
Country	:	US
Telephone Number	:	617-877-2265
Fax Number	:	781-826-0054

Provider Business Practice Location Address
First Line	:	290 SPRING ST
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-2768
Country	:	US
Telephone Number	:	617-877-2265
Fax Number	:	781-826-0054

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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