Healthcare Provider Details

I. General information

NPI: 1326606468
Provider Name (Legal Business Name): KRISTEN KOZEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 KOZEY RD
EASTFORD CT
06242-9712
US

IV. Provider business mailing address

150 COUNTRY SQUIRE DR UNIT 5202
CROMWELL CT
06416-2647
US

V. Phone/Fax

Practice location:
  • Phone: 860-933-8587
  • Fax:
Mailing address:
  • Phone: 860-455-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number012424
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: