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Individual

MRS. JACQUELINE JUDETH COSTELLO-ATHERTON-ELY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.P.C.

Contact information

Practice address
516 MOOSIC RD, OLD FORGE, PA 18518-2027
(570) 562-1166
(570) 457-3779
Mailing address
516 MOOSIC RD, OLD FORGE, PA 18518-2027
(570) 562-1166
(570) 457-3779

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC002586
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0015080380002
PA
Enumeration date
10/26/2006
Last updated
07/08/2007
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