MEDICARE: JOANNE COSTLOW LCSW

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	1041C0700X	Clinical Social Worker	0904015156	VA

General Provider Information

NPI Number	:	1891480489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE COSTLOW LCSW

Provider Business Mailing Address
First Line	:	2602 HANOVER AVE # B
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4011
Country	:	US
Telephone Number	:	410-259-9850
Fax Number	:	804-977-9957

Provider Business Practice Location Address
First Line	:	2222 MONUMENT AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-2724
Country	:	US
Telephone Number	:	410-259-9850
Fax Number	:	804-977-9957

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

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	10/13/2025

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