Healthcare Provider Details

I. General information

NPI: 1558946624
Provider Name (Legal Business Name): MIZUKI KOJIMA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WISCONSIN AVENUE NW # 850
WASHINGTON DC
20007
US

IV. Provider business mailing address

2500 WISCONSIN AVE NW APT 850
WASHINGTON DC
20007-4534
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-8197
  • Fax:
Mailing address:
  • Phone: 202-415-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082762
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61634159
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: