Individual
ELISSA KATE KOZLOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1745 BROADWAY FL 17, NEW YORK, NY 10019-4642
(212) 851-8100
(212) 537-0102
Mailing address
310 E 75TH ST, 2H, NEW YORK, NY 10021-3314
(914) 715-3012
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
022411
NY
Other
Enumeration date
12/03/2017
Last updated
03/17/2018
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