Healthcare Provider Details

I. General information

NPI: 1225005507
Provider Name (Legal Business Name): ANGELINE KOZIARA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 WICKENDEN ST
PROVIDENCE RI
02903-4422
US

IV. Provider business mailing address

11 HALL PL
CRANSTON RI
02905-5111
US

V. Phone/Fax

Practice location:
  • Phone: 401-263-7400
  • Fax: 401-861-3808
Mailing address:
  • Phone: 401-263-7400
  • Fax: 401-861-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01412
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: