Healthcare Provider Details

I. General information

NPI: 1255524682
Provider Name (Legal Business Name): TOVA ELBERG PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SZOLD STREET APT 29
RAMAT HASHARON ISRAEL
47225
IL

IV. Provider business mailing address

48 SZOLD STREET APT 29
RAMAT HASHARON ISRAEL
47225
IL

V. Phone/Fax

Practice location:
  • Phone: 97235491375
  • Fax: 97235493127
Mailing address:
  • Phone: 97235491375
  • Fax: 97235493127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number010464
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number010464
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010464
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number010464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: