Healthcare Provider Details

I. General information

NPI: 1730376534
Provider Name (Legal Business Name): HELENA M KOZEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 S MAIN ST
COLCHESTER CT
06415-1405
US

IV. Provider business mailing address

244 S MAIN ST
COLCHESTER CT
06415-1405
US

V. Phone/Fax

Practice location:
  • Phone: 860-836-9128
  • Fax: 860-537-5426
Mailing address:
  • Phone: 860-836-9128
  • Fax: 860-537-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1861
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: