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NPI Code Detail

MEDICARE: MS. JUDITH MIZRACHI L.C.P.C.

MEDICARE: MS. JUDITH MIZRACHI L.C.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180-005474IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11634661OTHERILBCBS
2U0348-0591OTHERILCIGNA

General Provider Information

NPI Number : 1386724243
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUDITH MIZRACHI L.C.P.C.
Provider Business Mailing Address
First Line : 1347 W GREENLEAF AVE
Second Line : UNIT 2
City : CHICAGO
State : IL
Zip : 60626-2916
Country : US
Telephone Number : 773-575-4307
Fax Number : 773-764-2038
Provider Business Practice Location Address
First Line : 5419 N SHERIDAN RD
Second Line : SUITE 103 A
City : CHICAGO
State : IL
Zip : 60640-1964
Country : US
Telephone Number : 773-575-4307
Fax Number : 773-764-2038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 01/05/2011

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