Healthcare Provider Details

I. General information

NPI: 1831007483
Provider Name (Legal Business Name): SAMANTHA KOZIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 28TH ST
BOULDER CO
80303-1002
US

IV. Provider business mailing address

1185 BEAR MOUNTAIN DR APT A
BOULDER CO
80305-6266
US

V. Phone/Fax

Practice location:
  • Phone: 720-810-2335
  • Fax:
Mailing address:
  • Phone: 215-370-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0009926781
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: