Provider Demographics
NPI:1679132294
Name:COZENS, KAITLYN TAYLOR (MSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:TAYLOR
Last Name:COZENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79571 PORT ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1270
Mailing Address - Country:US
Mailing Address - Phone:760-533-0749
Mailing Address - Fax:
Practice Address - Street 1:81557 DR CARREON BLVD STE C9
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5562
Practice Address - Country:US
Practice Address - Phone:760-391-6999
Practice Address - Fax:760-399-6998
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA892611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical