Provider Demographics
NPI:1437120862
Name:KOCZAJA, DOROTHY (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:KOCZAJA
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 1:4020 W GOELLER BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8273
Mailing Address - Country:US
Mailing Address - Phone:812-342-2860
Mailing Address - Fax:812-342-2849
Practice Address - Street 1:4020 W GOELLER BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8273
Practice Address - Country:US
Practice Address - Phone:812-342-2860
Practice Address - Fax:812-342-2849
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003678A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000392363OtherANTHEM BC BS
IN000000392363OtherANTHEM BC BS