Healthcare Provider Details

I. General information

NPI: 1619883618
Provider Name (Legal Business Name): JOHN MICHAEL KOCZELA LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ALBEMARLE ST NW SUITE 500 (5TH FLOOR)
WASHINGTON DC
20016
US

IV. Provider business mailing address

4000 ALBEMARLE ST NW SUITE 500 (5TH FLOOR)
WASHINGTON DC
20016
US

V. Phone/Fax

Practice location:
  • Phone: 202-531-5385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200006912
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: