Healthcare Provider Details

I. General information

NPI: 1538724042
Provider Name (Legal Business Name): AJETA HOZANOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MAIN ST
ONEONTA NY
13820-2527
US

IV. Provider business mailing address

242 MAIN ST
ONEONTA NY
13820-2527
US

V. Phone/Fax

Practice location:
  • Phone: 607-431-1030
  • Fax:
Mailing address:
  • Phone: 607-431-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: