Healthcare Provider Details

I. General information

NPI: 1942506381
Provider Name (Legal Business Name): TAMARA JUDITH GITTELSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 04/21/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 N RAVENSWOOD AVE STE 309
CHICAGO IL
60613-1192
US

IV. Provider business mailing address

2773 N HAMPDEN CT APT 502
CHICAGO IL
60614-2333
US

V. Phone/Fax

Practice location:
  • Phone: 206-351-2655
  • Fax:
Mailing address:
  • Phone: 206-351-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008767
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number180.008767
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: