Healthcare Provider Details

I. General information

NPI: 1295979912
Provider Name (Legal Business Name): EDWARD J. COZZA PH.D., SCHOOL PSYCHO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5174 BLAZER PARKWAY
DUBLIN OH
43017
US

IV. Provider business mailing address

5174 BLAZER PARKWAY
DUBLIN OH
43017
US

V. Phone/Fax

Practice location:
  • Phone: 614-792-9104
  • Fax: 614-792-2382
Mailing address:
  • Phone: 614-792-9104
  • Fax: 614-792-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP433
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: