1821295817 NPI number — MRS. KIMBERLY CEGELKA KOZLOWSKI LCSW

Table of content: MRS. KIMBERLY CEGELKA KOZLOWSKI LCSW (NPI 1821295817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821295817 NPI number — MRS. KIMBERLY CEGELKA KOZLOWSKI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZLOWSKI
Provider First Name:
KIMBERLY
Provider Middle Name:
CEGELKA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CEGELKA
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821295817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GRIFFIN HOSPITAL
Provider Second Line Business Mailing Address:
130 DIVISION STREET
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-732-7550
Provider Business Mailing Address Fax Number:
203-732-1550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GRIFFIN HOSPITAL
Provider Second Line Business Practice Location Address:
130 DIVISION STREET
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-732-7550
Provider Business Practice Location Address Fax Number:
203-732-1550
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 7072 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004040549 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004025219 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004041927 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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