Kyle Kozelka, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

120650 Issued in MA

Practice address

Northeastern University, 360 Huntington Avenue
135 Forsyth BLDG, Uhcs
Boston, MA 02215-5400

Phone

(617) 373-2772

NPI assigned

Aug 15, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1124544754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UHCS, NORTHEASTERN UNIVERSITY, 360 HUNTINGTON AVE",
            "address_2": "135 FORSYTH BUILDING",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "617-373-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NORTHEASTERN UNIVERSITY, 360 HUNTINGTON AVENUE",
            "address_2": "135 FORSYTH BLDG, UHCS",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-373-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZELKA",
        "first_name": "KYLE",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-15",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "120650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Michael Kozak, MD
• Harry PW Kozakewich, MD
• Saliha Kozan, PHD
• Mariel Kozberg, MD
• Lindsay Klofas Kozek, MD, PHD
• Henry Koziel, M.D.
• Elizabeth Ann Kozik, LMHC
• Elliott D. Kozin, MD
• Robert Koziol, RPH
• Sophia Kozlowsky

• Clinical Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.