Healthcare Provider Details

I. General information

NPI: 1578213815
Provider Name (Legal Business Name): BRITTANY KOZLOWSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CALLE CHAMISAL
ESPANOLA NM
87532-2976
US

IV. Provider business mailing address

1826 LAS TUNAS DR
LAS CRUCES NM
88011-4952
US

V. Phone/Fax

Practice location:
  • Phone: 505-372-4511
  • Fax:
Mailing address:
  • Phone: 708-646-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-11991
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: