Provider Demographics
NPI:1356783047
Name:COZZA, JESSICA L (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:COZZA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 LORIMER ST
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1953
Mailing Address - Country:US
Mailing Address - Phone:505-699-9630
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 413B
Practice Address - Street 2:FORT TOTTEN
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11359
Practice Address - Country:US
Practice Address - Phone:718-352-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001895-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist