Provider Demographics
NPI:1841410529
Name:BOZYMSKI, EDWARD RICHARD (MS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:RICHARD
Last Name:BOZYMSKI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 NW PROFESSIONAL PLZ
Mailing Address - Street 2:SUITE F
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3854
Mailing Address - Country:US
Mailing Address - Phone:614-263-2113
Mailing Address - Fax:614-263-2115
Practice Address - Street 1:1660 NW PROFESSIONAL PLZ
Practice Address - Street 2:SUITE F
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3854
Practice Address - Country:US
Practice Address - Phone:614-263-2113
Practice Address - Fax:614-263-2115
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0498037Medicaid
OH0498037Medicaid