Provider Demographics
NPI:1568869584
Name:KOZINA, MARY C (LISW-S)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:KOZINA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1612
Mailing Address - Country:US
Mailing Address - Phone:440-639-3509
Mailing Address - Fax:440-352-2040
Practice Address - Street 1:9220 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1612
Practice Address - Country:US
Practice Address - Phone:440-639-3509
Practice Address - Fax:440-352-2040
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0009641-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker