Provider Demographics
NPI:1790132223
Name:KOZNE, JEREMY (PHD)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:KOZNE
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 1:2000 15TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2627
Mailing Address - Country:US
Mailing Address - Phone:707-988-6861
Mailing Address - Fax:
Practice Address - Street 1:2000 15TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-2627
Practice Address - Country:US
Practice Address - Phone:707-988-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical