Basic Information
| Provider Information | |||||||||
| NPI: | 1144548017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTELLO | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1936 CARLOTTA DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256828000 | ||||||||
| FaxNumber: | 9256870746 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 OAK GROVE RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945182801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256858414 | ||||||||
| FaxNumber: | 9256851435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2010 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW 19732 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW29751 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.