Individual
MS. ELLEN TERESA COSTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
2741 INDIAN SCHOOL RD NE, ALBUQUERQUE, NM 87106-2653
(505) 255-8682
(505) 255-7890
Mailing address
580 CARMEL RD, BELEN, NM 87002-9200
(505) 764-6409
(505) 764-6455
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-04603
NM
Other
Enumeration date
06/20/2006
Last updated
07/07/2009
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