Courtney Costello, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089211 Issued in NY

Practice address

750 Waverly Ave
Holtsville, NY 11742-1108

Phone

(631) 218-4115

NPI assigned

May 23, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1710334545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W 4TH ST APT 82",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722129",
            "telephone_number": "631-327-1143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 WAVERLY AVE",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117421108",
            "telephone_number": "631-218-4115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 NY-112",
            "address_purpose": "LOCATION",
            "city": "Coram",
            "state": "NY",
            "postal_code": "11727",
            "country_code": "US",
            "telephone_number": "631-920-8500",
            "fax_number": "631-920-8501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "COURTNEY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-23",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "096358-1",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "089211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soumitra Chatterjee, M.D.
• Cheryl D. Martin
• Vinod Chhabra, DDS
• Lisa Maria Christy, BA,SI
• Evan Paul Cohen I, M.S. SPECIAL ED.
• Christine Marie Cracchiolo
• Trisha Crawford
• Mary Jeanne Creamer, N.P.
• Creative Health Unlimited
• Clova E Crisp, RPN

• Clinical Social Worker in Holtsville, NY
• Providers in Holtsville, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.