Individual
DR. ELENE JESSICA COSTUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
168 HILL ST, SOUTHAMPTON, NY 11968-5310
(631) 283-3356
Mailing address
492 N MAIN ST # 2, SOUTHAMPTON, NY 11968-2804
(631) 726-6494
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
015628-1
NY
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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