MEDICARE: KIMBERLY H KOSSOFF

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740918556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY H KOSSOFF

Provider Business Mailing Address
First Line	:	109 JUNIPER RD
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-3014
Country	:	US
Telephone Number	:	516-399-7939
Fax Number	:

Provider Business Practice Location Address
First Line	:	459 COLUMBUS AVE # 1032
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5129
Country	:	US
Telephone Number	:	917-796-0106
Fax Number	:

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

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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Directions to “ KIMBERLY H KOSSOFF ” Practice Location

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