Healthcare Provider Details

I. General information

NPI: 1801186291
Provider Name (Legal Business Name): BRANDON KOZAR PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EASTON OVAL SUITE 450
COLUMBUS OH
43219-6036
US

IV. Provider business mailing address

2 EASTON OVAL SUITE 450
COLUMBUS OH
43219-6036
US

V. Phone/Fax

Practice location:
  • Phone: 614-475-9500
  • Fax: 614-475-9821
Mailing address:
  • Phone: 614-475-9500
  • Fax: 614-475-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: