Provider Demographics
NPI:1457403776
Name:KOZITZA, LINDA PEPPER (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:PEPPER
Last Name:KOZITZA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:KOZITZA
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3 HAMILTON LNDG STE 230
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-2848
Mailing Address - Country:US
Mailing Address - Phone:415-883-8332
Mailing Address - Fax:415-883-8385
Practice Address - Street 1:3 HAMILTON LNDG STE 230
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-2848
Practice Address - Country:US
Practice Address - Phone:415-883-8332
Practice Address - Fax:415-883-8385
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12132103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist