Provider Demographics
NPI:1376773911
Name:KOLOZIAN, KRISTIN (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KOLOZIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 BROADWAY STE 1205
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2007
Mailing Address - Country:US
Mailing Address - Phone:917-716-4834
Mailing Address - Fax:718-613-4688
Practice Address - Street 1:1123 BROADWAY STE 1205
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2007
Practice Address - Country:US
Practice Address - Phone:917-716-4834
Practice Address - Fax:718-613-4688
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018060-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist