=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306755301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY KOZIKOWSKI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2026
-----------------------------------------------------
Last Update Date | 09/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 MARINE ST
-----------------------------------------------------
City | THOMASTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06787-1470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-458-6921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 PARK ST PO BOX 72
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06782-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 7712
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------