Provider Demographics
NPI:1912350398
Name:KOZAK, JESSICA HORTON (PHD, BCBA-D)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HORTON
Last Name:KOZAK
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HORTON
Other - Last Name:KOZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:136 E 76TH ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2830
Mailing Address - Country:US
Mailing Address - Phone:626-430-8635
Mailing Address - Fax:
Practice Address - Street 1:136 E 76TH ST APT 3F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2830
Practice Address - Country:US
Practice Address - Phone:626-430-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NY001843-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No252Y00000XAgenciesEarly Intervention Provider Agency