Provider Demographics
NPI:1255656773
Name:AMY KOZIARSKI LISW LLC
Entity type:Organization
Organization Name:AMY KOZIARSKI LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZIARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-725-1203
Mailing Address - Street 1:5800 MONROE ST STE H2
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2260
Mailing Address - Country:US
Mailing Address - Phone:419-343-7737
Mailing Address - Fax:567-249-0114
Practice Address - Street 1:5800 MONROE ST STE H2
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2260
Practice Address - Country:US
Practice Address - Phone:419-343-7737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 10000161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty