Provider Demographics
NPI:1225348659
Name:KOZMARY, CYNTHIA NANETTE (MFT, LADC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NANETTE
Last Name:KOZMARY
Suffix:
Gender:F
Credentials:MFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 EL CAMINO AVE #101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-380-3210
Mailing Address - Fax:702-380-3212
Practice Address - Street 1:2851 EL CAMINO AVE #200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-380-3210
Practice Address - Fax:702-380-3212
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01289-L101YA0400X
NV01140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)