Individual
DR. ELLEN M. COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6416
(401) 455-6293
Mailing address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6416
(401) 455-6293
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS00412
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24002-0
BLUE CROSS
RI
01
—
406371
BLUE CHIP
RI
01
—
61-11464
UBH
RI
Enumeration date
10/02/2006
Last updated
07/08/2007
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