Healthcare Provider Details

I. General information

NPI: 1093368813
Provider Name (Legal Business Name): HILLARY MAY KOZLOSKI-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2019
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MAIN ST FL 3
BROCKTON MA
02301-4342
US

IV. Provider business mailing address

8 N WORCESTER ST
NORTON MA
02766-2028
US

V. Phone/Fax

Practice location:
  • Phone: 508-586-2660
  • Fax:
Mailing address:
  • Phone: 508-223-7856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000225940
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: