| Doctor Name: | MRS. JACQUELINE JUDETH COSTELLO-ATHERTON-ELY |
| NPI Number: | 1568547313 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C. |
| License Number: | PC002586 |
| Business Practice Address: | 516 Moosic Rd Old Forge, PA - 185182027 |
| Business Phone Number: | 5705621166 |
| Business Fax Number: | 5704573779 |
| Mailing Address: | 516 Moosic Rd, OLD FORGE |
| State: | PA |
| Postal Code: | 185182027 |
| Phone Number: | 5705621166 |
| Fax Number: | 5704573779 |
| NPI Enumeration Date: | 10/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC002586 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |