Healthcare Provider Details

I. General information

NPI: 1346077807
Provider Name (Legal Business Name): ELIZABETH KOBZIK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 CENTRE ST
JAMAICA PLAIN MA
02130-3495
US

IV. Provider business mailing address

288 WALNUT ST STE 200
NEWTON MA
02460-1994
US

V. Phone/Fax

Practice location:
  • Phone: 617-524-3116
  • Fax:
Mailing address:
  • Phone: 844-716-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2141222
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: