Healthcare Provider Details

I. General information

NPI: 1265917900
Provider Name (Legal Business Name): ERIC J KOZOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ERIC J. KOZOL LICSW, JD

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S BRADFORD ST
NORTH ANDOVER MA
01845-1327
US

IV. Provider business mailing address

95 S BRADFORD ST
NORTH ANDOVER MA
01845-1327
US

V. Phone/Fax

Practice location:
  • Phone: 617-256-7520
  • Fax:
Mailing address:
  • Phone: 617-256-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107758-SW-LICSW
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: