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General NPI Number Information
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NPI Number | 1518472398
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Entity Type | Individual
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Provider Name | ELISSA KATE KOZLOV PHD
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Gender | Female
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1745 BROADWAY FL 17
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City | NEW YORK
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State | NY
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Zip | 10019-4642
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Country | US
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Telephone | 212-851-8100
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Fax | 212-537-0102
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Provider Business Mailing Address
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Address Line | 310 E 75TH ST 2H
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City | NEW YORK
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State | NY
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Zip | 10021-3314
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Country | US
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Telephone | 914-715-3012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 022411
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License Number State | NY
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