Provider Demographics
NPI:1912667528
Name:KOZINA-EVANOSKI, KIM ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANN
Last Name:KOZINA-EVANOSKI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2715
Mailing Address - Country:US
Mailing Address - Phone:607-936-1771
Mailing Address - Fax:607-936-2648
Practice Address - Street 1:77 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2715
Practice Address - Country:US
Practice Address - Phone:607-936-1771
Practice Address - Fax:607-936-2648
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0443841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical