Provider Demographics
NPI:1710039391
Name:KOSTON, ZOE A
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:A
Last Name:KOSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 LAMARCK DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1108
Mailing Address - Country:US
Mailing Address - Phone:716-832-9363
Mailing Address - Fax:
Practice Address - Street 1:7 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-2523
Practice Address - Country:US
Practice Address - Phone:716-505-5630
Practice Address - Fax:716-892-1936
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035571-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker