Provider Demographics
NPI:1790073013
Name:FLECK, CAROLINE COZZA (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:COZZA
Last Name:FLECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 N SHORELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4605
Mailing Address - Country:US
Mailing Address - Phone:650-429-8828
Mailing Address - Fax:
Practice Address - Street 1:451 N SHORELINE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-4605
Practice Address - Country:US
Practice Address - Phone:650-429-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60248859103TC0700X
CAPSY 25889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical