Provider Demographics
NPI:1386055838
Name:KOZIOL, DINA (LAC)
Entity type:Individual
Prefix:MRS
First Name:DINA
Middle Name:
Last Name:KOZIOL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SAMI DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2912
Mailing Address - Country:US
Mailing Address - Phone:732-915-6570
Mailing Address - Fax:
Practice Address - Street 1:56 SAMI DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2912
Practice Address - Country:US
Practice Address - Phone:732-915-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00172800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor