Healthcare Provider Details

I. General information

NPI: 1164469433
Provider Name (Legal Business Name): KATHERINE KOZITZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST CLARK 1
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

1 ARSENAL MARKET PL
WATERTOWN MA
02472-5018
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5054
  • Fax: 617-499-5465
Mailing address:
  • Phone: 617-673-1851
  • Fax: 617-499-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number220719
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: