Provider Demographics
NPI:1417383332
Name:KOSOFSKY, NEIL (LLMFT)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:KOSOFSKY
Suffix:
Gender:M
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25960 RAINE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1011
Mailing Address - Country:US
Mailing Address - Phone:323-533-3982
Mailing Address - Fax:
Practice Address - Street 1:27172 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0963
Practice Address - Country:US
Practice Address - Phone:248-546-0407
Practice Address - Fax:248-548-1925
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist