Healthcare Provider Details

I. General information

NPI: 1871607747
Provider Name (Legal Business Name): RACHEL M KOZLOWSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 5TH AVE
NEW YORK NY
10028-0134
US

IV. Provider business mailing address

1025 5TH AVE 7DS
NEW YORK NY
10028-0134
US

V. Phone/Fax

Practice location:
  • Phone: 917-583-7620
  • Fax:
Mailing address:
  • Phone: 917-583-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014885
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: