Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 44SC05799500 | NJ |
NPI | 1245710433 |
---|---|
Provider Name | Ms. Katelyn Mary Costello |
First Address | Caldwell, NJ 07006-5113 |
Second Address | Fair Lawn, NJ 07410-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |