Provider Demographics
NPI:1447990528
Name:JENNIFER A COSTELLO LCSW LLC
Entity type:Organization
Organization Name:JENNIFER A COSTELLO LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-213-2385
Mailing Address - Street 1:329 MALAPARDIS RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3261
Mailing Address - Country:US
Mailing Address - Phone:201-213-2385
Mailing Address - Fax:973-843-1600
Practice Address - Street 1:329 MALAPARDIS RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-3261
Practice Address - Country:US
Practice Address - Phone:201-213-2385
Practice Address - Fax:973-843-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health