MEDICARE: DR. MARJORIE A. KOSOY ED. D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	22131	TX

General Provider Information

NPI Number	:	1528084597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARJORIE A. KOSOY ED. D., P.C.

Provider Business Mailing Address
First Line	:	6300 WEST LOOP S
Second Line	:	SUITE 240
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2900
Country	:	US
Telephone Number	:	713-621-2700
Fax Number	:	713-839-7644

Provider Business Practice Location Address
First Line	:	6300 WEST LOOP S
Second Line	:	SUITE 240
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2900
Country	:	US
Telephone Number	:	713-621-2700
Fax Number	:	713-839-7644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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