Provider Demographics
NPI:1033220876
Name:KOZA, CHARLES ANDREW (LICSW, ACHP-SW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ANDREW
Last Name:KOZA
Suffix:
Gender:M
Credentials:LICSW, ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0016
Mailing Address - Country:US
Mailing Address - Phone:978-682-9963
Mailing Address - Fax:
Practice Address - Street 1:1 MARC LN
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3236
Practice Address - Country:US
Practice Address - Phone:978-682-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1140491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical