Kyle Kozelka, LICSW
Social Worker, Clinical in Boston, MA. Individual provider (NPI-1).
NPI number1124544754
StatusActive
Last updated in NPPESDec 11, 2019
Details
- NPI
- 1124544754
- Entity type
- Individual (NPI-1)
- Name
- Mr. Kyle Kozelka
- Credential
- LICSW
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 15, 2017
- Certification date
- Dec 11, 2019
- Last updated
- Dec 11, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 120650 | MA | Yes |
Practice location
Northeastern University, 360 Huntington Avenue135 Forsyth Bldg, Uhcs
Boston, MA 02215-5400
Phone 617-373-2772
Mailing address
Uhcs, Northeastern University, 360 Huntington Ave135 Forsyth Building
Boston, MA 02115
Phone 617-373-2772
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