Provider Demographics
NPI:1992371785
Name:KOZEL, PETER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:KOZEL
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 1:51 SIMON CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-8526
Mailing Address - Country:US
Mailing Address - Phone:724-467-2198
Mailing Address - Fax:
Practice Address - Street 1:2215 FOREST HILLS DR STE 38
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1099
Practice Address - Country:US
Practice Address - Phone:717-540-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10402768-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical