Costallos, Suzanne
Costallos, Suzanne is an individual health care provider with primary practice located at 710 Bucksport Rd , Ellsworth ME 04605-2722. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Costallos, Suzanne can be contacted via phone (207) 667-6890.Contact Information
Primary practice address
710 Bucksport Rd
Ellsworth ME 04605-2722
Phone: (207) 667-6890
Fax: (207) 667-6457
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | LC10650 | Maine |
Profile Details
| NPI number | 1134344724 |
|---|---|
| LBN Legal business name | Costallos, Suzanne |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 17th, 2007 |
| Last updated | Aug 13th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134344724 | NPPES |
| Maine | MEDICAID | 431803199 |
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