Thomas Costello, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004756 Issued in NC

Practice address

335 S White St
Wake Forest, NC 27587-2916

Phone

(984) 389-0566

NPI assigned

Jul 14, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tidewater Psychotherapy Services

  • Addiction (Substance Use Disorder) Counselor
  • Virginia Beach, VA
  • NPI 1164536496
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1679702427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275880024",
            "telephone_number": "984-389-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 S WHITE ST",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275872916",
            "telephone_number": "984-389-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-14",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kywana Renee Corbett, LRT, CTRS
• Tamia Corbett
• Erika Evon Corey, COTA/L
• Cornerstone Caregiving East LLC
• Cornerstone Family Services LLC
• Cothran Innovations LLC (Always Best Care Senior Services)
• Shawn M Cothran
• Anna Christine Courter, RDH
• Richard Matthew Cox, DPT
• Susan P Cox, PT

• Clinical Social Worker in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.