Provider Demographics
NPI:1649863705
Name:KOZEY GREENE WELLNESS
Entity type:Organization
Organization Name:KOZEY GREENE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZEY GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-933-8587
Mailing Address - Street 1:77 KOZEY RD
Mailing Address - Street 2:
Mailing Address - City:EASTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06242-9712
Mailing Address - Country:US
Mailing Address - Phone:860-933-8587
Mailing Address - Fax:
Practice Address - Street 1:77 KOZEY RD
Practice Address - Street 2:
Practice Address - City:EASTFORD
Practice Address - State:CT
Practice Address - Zip Code:06242-9712
Practice Address - Country:US
Practice Address - Phone:860-933-8587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty