Provider Demographics
NPI:1356081533
Name:KOZMOSKI, JESSIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:KOZMOSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE WAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3113
Mailing Address - Country:US
Mailing Address - Phone:973-219-3593
Mailing Address - Fax:
Practice Address - Street 1:2 VILLAGE WAY UNIT 1
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3113
Practice Address - Country:US
Practice Address - Phone:973-219-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060688001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical