Provider Demographics
NPI:1487182101
Name:KOZLOVA, ELENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:KOZLOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 EL MONTE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2396
Mailing Address - Country:US
Mailing Address - Phone:831-297-0567
Mailing Address - Fax:650-966-1807
Practice Address - Street 1:1061 EL MONTE AVE STE B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2396
Practice Address - Country:US
Practice Address - Phone:831-297-0567
Practice Address - Fax:650-966-1807
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29195103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist