Provider Demographics
NPI:1508241134
Name:KOSIA-IG-LLC
Entity Type:Organization
Organization Name:KOSIA-IG-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:OLESYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAKOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-248-4708
Mailing Address - Street 1:1044 CASTELLO DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-1900
Mailing Address - Country:US
Mailing Address - Phone:230-248-4708
Mailing Address - Fax:
Practice Address - Street 1:1044 CASTELLO DR STE 210
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-1900
Practice Address - Country:US
Practice Address - Phone:239-248-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty