Healthcare Provider Details

I. General information

NPI: 1992371785
Provider Name (Legal Business Name): PETER KOZEL PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FOREST HILLS DR STE 38
HARRISBURG PA
17112-1099
US

IV. Provider business mailing address

51 SIMON CT
MECHANICSBURG PA
17050-8526
US

V. Phone/Fax

Practice location:
  • Phone: 717-540-5353
  • Fax:
Mailing address:
  • Phone: 724-467-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10402768-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: