Individual
MS. MARY ANNE LISA COSTERELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LADC
Contact information
Practice address
110 NATIONAL DR, GLASTONBURY, CT 06033-4371
(860) 657-8910
Mailing address
110 NATIONAL DR, GLASTONBURY, CT 06033-4371
(860) 657-8910
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
#000527
CT
Other
Enumeration date
04/14/2008
Last updated
04/08/2024
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