Provider Demographics
NPI:1619077203
Name:KOSMICKI, FRANK XAVIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:XAVIER
Last Name:KOSMICKI
Suffix:
Gender:M
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:PO BOX 3035
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3035
Mailing Address - Country:US
Mailing Address - Phone:618-203-6730
Mailing Address - Fax:618-529-3171
Practice Address - Street 1:231 W MAIN ST
Practice Address - Street 2:SUITE 1W
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2948
Practice Address - Country:US
Practice Address - Phone:618-203-6730
Practice Address - Fax:618-529-3171
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist