Healthcare Provider Details

I. General information

NPI: 1932072378
Provider Name (Legal Business Name): CATHERINE KOZAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7802 FARNSWORTH ST
PHILADELPHIA PA
19152-3409
US

IV. Provider business mailing address

7802 FARNSWORTH ST
PHILADELPHIA PA
19152-3409
US

V. Phone/Fax

Practice location:
  • Phone: 267-231-7207
  • Fax:
Mailing address:
  • Phone: 267-231-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018856
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: