Provider Demographics
NPI:1952723025
Name:KOZAK, WENDY (CCMA, CCP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:KOZAK
Suffix:
Gender:F
Credentials:CCMA, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 TOPSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-1618
Mailing Address - Country:US
Mailing Address - Phone:609-709-8196
Mailing Address - Fax:
Practice Address - Street 1:172 TOPSIDE RD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-1618
Practice Address - Country:US
Practice Address - Phone:609-709-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R3E7C5P9101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor