Active NPI
Angela Costello, LMFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1124150750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 53654
- Practice address
- 6330 San Vicente Blvd Ste 520
Los Angeles, CA 90048-5455 - Phone
- (310) 887-0657
- NPI assigned
- Mar 9, 2007
- Last updated
- Oct 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 53654 | CA | Primary |
Addresses
Primary practice location
6330 San Vicente Blvd Ste 520
Los Angeles, CA 90048-5455
Mailing address
6330 San Vicente Blvd Ste 520
Los Angeles, CA 90048-5455
Phone (310) 877-0657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 23, 2024 through Apr 23, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53654 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696723200000",
"number": "1124150750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6330 SAN VICENTE BLVD STE 520",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900485455",
"telephone_number": "310-877-0657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6330 SAN VICENTE BLVD STE 520",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900485455",
"telephone_number": "310-887-0657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLO",
"first_name": "ANGELA",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2023-10-08",
"certification_date": "2023-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "53654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
- Lindsay Anne Costantino, DDS
- Kaitlyn L. Costas, NP
- Costco Wholesale Corporation (Costco Hearing Aid #130)
- Costco Wholesale Corporation
- Costco Wholesale Corporation (Costco Wholesale #130)
- Cynthia M Costello, C.P.N.P.
- Gina Costello, M.S., CCC-SLP
- Megan Lynn Costello, M.S.
- Sara M. Costello, AMFT
- Jane Lim Costes, FNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.