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General NPI Number Information
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NPI Number | 1871870410
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Entity Type | Individual
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Provider Name | NANCY TARTAKOFF LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 9729 64TH RD
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City | REGO PARK
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State | NY
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Zip | 11374-2259
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Country | US
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Telephone | 718-896-3400
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Fax | 718-459-5621
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Provider Business Mailing Address
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Address Line | 6740 YELLOWSTONE BLVD 7J
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City | FOREST HILLS
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State | NY
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Zip | 11375-2668
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Country | US
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Telephone | 917-749-9561
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Fax |
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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 | 051658
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License Number State | NY
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