Provider Demographics
NPI:1164778387
Name:KOZIN, KEVIN M (LICSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:KOZIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SCHOOL ST # 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-5519
Mailing Address - Country:US
Mailing Address - Phone:781-325-1858
Mailing Address - Fax:617-249-1530
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 22
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-325-1858
Practice Address - Fax:617-249-1530
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1170081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical