Healthcare Provider Details

I. General information

NPI: 1518411958
Provider Name (Legal Business Name): NATALIA KAZAKOVA MS, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA KAZAKOVA MS, PSYD

II. Dates (important events)

Enumeration Date: 08/14/2016
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 N 28TH DRIVE BUILDING E
PHOENIX AZ
85029-4218
US

IV. Provider business mailing address

1616 N CENTRAL AVENUE
PHOENIX AZ
85004
US

V. Phone/Fax

Practice location:
  • Phone: 602-316-0724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-005610
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005610
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: