Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 79904 | CA |
NPI | 1003211343 |
---|---|
Provider Name | Olivia Kozarev |
First Address | El Cajon, CA 92021-4904 |
Second Address | El Cajon, CA 92021-4904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2014 |
Last Update Date | 17/03/2018 |