Provider Demographics
NPI:1043343023
Name:KAZAKOS, AMELIA (LCSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:KAZAKOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8323 LYRIC DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6870
Mailing Address - Country:US
Mailing Address - Phone:850-477-9660
Mailing Address - Fax:
Practice Address - Street 1:8323 LYRIC DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6870
Practice Address - Country:US
Practice Address - Phone:850-477-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW52811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical