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General NPI Number Information
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NPI Number | 1538296165
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Entity Type | Individual
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Provider Name | MICHELE ITSKOWITCH LICENSED CLINICAL SO
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1155 PARK AVENUE MEDICAL SUITE B
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City | NY
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State | NY
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Zip | 10128
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Country | US
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Telephone | 212-734-5491
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Fax | 212-987-8466
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Provider Business Mailing Address
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Address Line | 160 E 84 STREET APT 15G
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City | NY
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State | NY
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Zip | 10028
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Country | US
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Telephone | 212-734-5491
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Fax | 212-987-8466
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 052879
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License Number State | NY
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