Nicole Kozak, MA, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37AC00605200 Issued in NJ

Practice address

2001 Lincoln Dr W Ste a
Marlton, NJ 08053-1531

Phone

(609) 417-7300

NPI assigned

Oct 22, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1841954161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 LINCOLN DR W STE A",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 LINCOLN DR W STE A",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531531",
            "telephone_number": "609-417-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZAK",
        "first_name": "NICOLE",
        "credential": "MA, LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-22",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00605200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.cornerstonebehavioral.com",
            "affiliation": "N",
            "address_1": "2001 Lincoln Dr W Ste A",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080531531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jacqueline Kornhaber, BCBA
• Karen Lynn Korobellis
• Emily Kostelnik, PHD
• Cap Koval, RPH
• Jennifer Kover, NP
• Daniel Paul Kramer, OD
• Agata Patrycja Kraszewska, FNP-C
• Tracy Krause, NP
• Kristin Lieberman, LPC LLC
• Roman Krol, M.D.

• Mental Health Counselor in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; 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.