Provider Demographics
NPI:1619371713
Name:KOZLOWSKI, DEIDRA ANNE (MA, MS, LPC)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:ANNE
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:MA, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:HAZLET TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-2949
Mailing Address - Country:US
Mailing Address - Phone:908-310-4644
Mailing Address - Fax:
Practice Address - Street 1:107 TINDALL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2321
Practice Address - Country:US
Practice Address - Phone:908-310-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00548900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional