Mary Joanne Costello LCSW

NPI 1639372204 - Social Worker - 1041C0700X

NPI Details
NPI 1639372204
Gender Female
Enumeration Date 06/08/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
5209 N CLARK ST
SUITE 2A
CHICAGO IL, 60640-2101, US
Phone (773) 506-1401
Fax
Business Location
5209 N CLARK ST
SUITE 2A
CHICAGO IL, 60640-2101, US
Phone (773) 506-1401
Fax
Toxanomy
Taxonomy Code 1041C0700X
License State Illinois
License Number 149-009666
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According to our database, Mary Joanne Costello LCSW NPI is 1639372204, taxonomy code is 1041C0700X and license number is 149-009666, license state is located at Illinois. Mary Joanne Costello LCSW physically located at 5209 N Clark St, Chicago IL, 60640-2101. NPI Number Mary Joanne Costello LCSW has the Individual type.

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1639372204 NPI number is provided on an as is basis without warranty of any kind. 1639372204 is maintained by the National Plan & Provider Enumeration System. The contents of Mary Joanne Costello LCSW are for informational purposes only.