Provider Demographics
NPI:1720018054
Name:KOZAK, ARNOLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:KOZAK
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 1:127 ROCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-3500
Mailing Address - Country:US
Mailing Address - Phone:802-233-5498
Mailing Address - Fax:
Practice Address - Street 1:127 ROCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-3500
Practice Address - Country:US
Practice Address - Phone:802-233-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1457Medicaid
VTVN1457Medicare ID - Type Unspecified