Provider Demographics
NPI:1801186291
Name:KOZAR, BRANDON (PSYD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:KOZAR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EASTON OVAL
Mailing Address - Street 2:SUITE 450
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6036
Mailing Address - Country:US
Mailing Address - Phone:614-475-9500
Mailing Address - Fax:614-475-9821
Practice Address - Street 1:2 EASTON OVAL
Practice Address - Street 2:SUITE 450
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6036
Practice Address - Country:US
Practice Address - Phone:614-475-9500
Practice Address - Fax:614-475-9821
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical