Healthcare Provider Details

I. General information

NPI: 1538473434
Provider Name (Legal Business Name): ELLEN KOZYANSKY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 12/26/2017
Certification Date:
Deactivation Date: 03/02/2011
Reactivation Date: 03/14/2014

III. Provider practice location address

10819 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-1034
US

IV. Provider business mailing address

10819 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-1034
US

V. Phone/Fax

Practice location:
  • Phone: 718-845-2620
  • Fax:
Mailing address:
  • Phone: 718-845-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number078151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: