Active NPI
Michelle Grassa Kozak, LCPC
- Professional Counselor
- Havre de Grace, MD
National Provider Identifier
1821531708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC7500
- Practice address
- 557 Green St
Havre de Grace, MD 21078-2930 - Phone
- (410) 937-0876
- Fax
- (410) 939-2219
- NPI assigned
- Nov 28, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LC7500 | MD | Primary |
Addresses
Primary practice location
557 Green St
Havre de Grace, MD 21078-2930
Mailing address
557 Green St
Havre de Grace, MD 21078-2930
Phone (410) 937-0876
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC7500 | MD | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480291200000",
"number": "1821531708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "557 GREEN ST",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210782930",
"telephone_number": "410-937-0876",
"fax_number": "410-939-2219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "557 GREEN ST",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210782930",
"telephone_number": "410-937-0876",
"fax_number": "410-939-2219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOZAK",
"first_name": "MICHELLE",
"middle_name": "GRASSA",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-28",
"last_updated": "2016-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC7500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Havre de Grace, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.