Healthcare Provider Details

I. General information

NPI: 1629131388
Provider Name (Legal Business Name): PAUL KOZODOY MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WASHINGTON AVENUE
NORTH HAVEN CT
06473
US

IV. Provider business mailing address

605 WASHINGTON AVENUE
NORTH HAVEN CT
06473
US

V. Phone/Fax

Practice location:
  • Phone: 203-530-2053
  • Fax: 203-889-0198
Mailing address:
  • Phone: 203-530-2053
  • Fax: 203-889-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000631
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000631
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: