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General NPI Number Information
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NPI Number | 1942506381
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Entity Type | Individual
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Provider Name | TAMARA JUDITH GITTELSON MA
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Gender | Female
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 4311 N RAVENSWOOD AVE STE 309
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City | CHICAGO
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State | IL
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Zip | 60613-1192
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Country | US
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Telephone | 206-351-2655
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Fax |
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Provider Business Mailing Address
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Address Line | 2773 N HAMPDEN CT APT 502
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City | CHICAGO
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State | IL
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Zip | 60614-2333
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Country | US
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Telephone | 206-351-6555
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.008767
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 180.008767
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.008767
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License Number State | IL
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