Provider Demographics
NPI:1073763504
Name:OZ, NITSA (LICSW)
Entity Type:Individual
Prefix:
First Name:NITSA
Middle Name:
Last Name:OZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NITSA
Other - Middle Name:
Other - Last Name:KEDEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 BLODGETT AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5620
Mailing Address - Country:US
Mailing Address - Phone:401-744-0867
Mailing Address - Fax:
Practice Address - Street 1:24 BLODGETT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5620
Practice Address - Country:US
Practice Address - Phone:401-744-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019281041C0700X
MA10252621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical