Provider Demographics
NPI:1154602530
Name:KOZIOROWSKI, MARY LYNNE (CADC II)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNNE
Last Name:KOZIOROWSKI
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3340 KEMPER STREET SUITE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:619-224-1673
Mailing Address - Fax:619-224-2538
Practice Address - Street 1:3340 KEMPER ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4907
Practice Address - Country:US
Practice Address - Phone:619-224-1673
Practice Address - Fax:619-224-2538
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8392202 CADC II101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)