Amanda Rose Kozakiewicz

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

404432 Issued in NY

Practice address

57 Washington Ave
Patchogue, NY 11772-2950

Phone

(631) 515-7841

Fax

(631) 518-2502

NPI assigned

Oct 10, 2022

Sex

Female

Sole proprietor

Yes

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Residences & Essential Enterprises, Inc.

  • Multi-Specialty Clinic/Center
  • Hauppauge, NY
  • NPI 1093863565

  NY

  Medicare reassignment NPD
• Family Residences and Essential Enterprises, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Old Bethpage, NY
  • NPI 1497943757
  NPD
• Calm Seas Psychotherapy, LCSW,PLLC

  • Clinical Social Worker
  • Mt Sinai, NY
  • NPI 1790247765
  NPD (past)
• Mary Kathleen Martin Nurse Practitioner in Psychiatry, PLLC

  • Prescribing (Medical) Psychologist
  • Riverhead, NY
  • NPI 1578921623
  NPD (past)
• Skills Unlimited, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oakdale, NY
  • NPI 1487789392
  NPD (past)

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1669197950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 WASHINGTON AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722950",
            "telephone_number": "631-515-7841",
            "fax_number": "631-518-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 WASHINGTON AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722950",
            "telephone_number": "631-515-7841",
            "fax_number": "631-518-2502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZAKIEWICZ",
        "first_name": "AMANDA",
        "middle_name": "ROSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Lewis Koppelman, DDS
• Edward J Kormylo, DPM
• Amanda Kosin
• Bonnie F Kotkin, MA, LMHC
• Elizabeth R Koulermos, OTR/L
• Lynn Christine Kramer, PA
• Rachel Kraushaar
• Adrian S Krueger, PA
• Adam Kruger, D.O.
• Jocelyn Kuan

• All providers in Patchogue, NY
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.