Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1138 | WI |
NPI | 1003045121 |
---|---|
Provider Name | Mr. Donald P. Cozza |
First Address | Muskego, WI 53150-4005 |
Second Address | Muskego, WI 53150-4005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 10/07/2009 |