Provider Demographics
NPI:1326606468
Name:KOZEY, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KOZEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COUNTRY SQUIRE DR UNIT 5202
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2647
Mailing Address - Country:US
Mailing Address - Phone:860-455-6331
Mailing Address - Fax:
Practice Address - Street 1:77 KOZEY RD
Practice Address - Street 2:
Practice Address - City:EASTFORD
Practice Address - State:CT
Practice Address - Zip Code:06242-9712
Practice Address - Country:US
Practice Address - Phone:860-933-8587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0124241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077550Medicaid