Healthcare Provider Details

I. General information

NPI: 1568858496
Provider Name (Legal Business Name): KARYN BRASKY KOZY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BOND ST SUITE 127
NAPERVILLE IL
60563-2388
US

IV. Provider business mailing address

1415 BOND ST SUITE 127
NAPERVILLE IL
60563-2388
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-9002
  • Fax: 630-355-9012
Mailing address:
  • Phone: 630-355-9002
  • Fax: 630-355-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: