Healthcare Provider Details

I. General information

NPI: 1699177139
Provider Name (Legal Business Name): ALISON KOZLOWSKI PH.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

2931 E BIDDLE ST
BALTIMORE MD
21213-3939
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • Fax: 443-923-1875
Mailing address:
  • Phone: 443-923-1886
  • Fax: 443-923-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-14289
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05580
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: