MEDICARE: IRENE KATHERINE KOSTELOS LMHC

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	LMH10003735	MA

General Provider Information

NPI Number	:	1750232484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE KATHERINE KOSTELOS LMHC

Provider Business Mailing Address
First Line	:	12 ANDREWS RD
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1359
Country	:	US
Telephone Number	:	508-596-7975
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 ANDREWS RD
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1359
Country	:	US
Telephone Number	:	508-596-7975
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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