MRS. Jacqueline Judeth Costello-Atherton-Ely, L.P.C.
NPI #1568547313 in Old Forge, Pennsylvania
Provider Information
- NPI Number
- 1568547313
- Entity Type
- Individual
- Name
- MRS. Jacqueline Judeth Costello-Atherton-Ely, L.P.C.
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Professional
- Credential
- L.P.C.
- Enumeration Date
- Oct 26, 2006
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 516 MOOSIC RD
- City
- Old Forge
- State
- Pennsylvania
- ZIP Code
- 18518-2027
- Phone
- (570) 562-1166
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Professional — Professional |
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