Healthcare Provider Details

I. General information

NPI: 1720018054
Provider Name (Legal Business Name): ARNOLD KOZAK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ROCKBRIDGE RD
MILLS RIVER NC
28759-3500
US

IV. Provider business mailing address

127 ROCKBRIDGE RD
MILLS RIVER NC
28759-3500
US

V. Phone/Fax

Practice location:
  • Phone: 802-233-5498
  • Fax:
Mailing address:
  • Phone: 802-233-5498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number669
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: