Individual
LAUREN COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
20 VINING ST, BOSTON, MA 02115-6115
(617) 626-9670
Mailing address
75 FENWOOD RD, BOSTON, MA 02115-6103
(617) 626-9670
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2274530
MA
Other
Enumeration date
09/14/2011
Last updated
06/12/2014
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