Provider Demographics
NPI:1699854331
Name:PIETRZAK, JENNIFER KOZLOWSKI (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KOZLOWSKI
Last Name:PIETRZAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 W. HORIZON RIDGE PKWY
Mailing Address - Street 2:#120
Mailing Address - City:HENDERSON
Mailing Address - State:NY
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-939-5236
Mailing Address - Fax:702-939-5237
Practice Address - Street 1:2441 W. HORIZON RIDGE PKWY
Practice Address - Street 2:#120
Practice Address - City:HENDERSON
Practice Address - State:NY
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-939-5236
Practice Address - Fax:702-939-5237
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4104-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101725Medicare ID - Type Unspecified