MEDICARE: YERUSALEM TASSISSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1174216238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YERUSALEM TASSISSA

Provider Business Mailing Address
First Line	:	445 E DBLN GRNVLL RD
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-3192
Country	:	US
Telephone Number	:	614-844-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 MORSE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-1382
Country	:	US
Telephone Number	:	614-844-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “ YERUSALEM TASSISSA ” Practice Location

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