Provider Demographics
NPI:1336428879
Name:KOSIK, MATHEW (LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:KOSIK
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7677 RIVERVIEW DR
Mailing Address - Street 2:APT 104
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7927
Mailing Address - Country:US
Mailing Address - Phone:616-970-5391
Mailing Address - Fax:616-970-5391
Practice Address - Street 1:7677 RIVERVIEW DR
Practice Address - Street 2:APT 104
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-7927
Practice Address - Country:US
Practice Address - Phone:616-970-5391
Practice Address - Fax:616-970-5391
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6801094209104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)