MEDICARE: DR. MARCI GITTLEMAN PH.D.

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
1	103TC0700X	Clinical Psychologist	1908	WI

General Provider Information

NPI Number	:	1417029984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCI GITTLEMAN PH.D.

Provider Business Mailing Address
First Line	:	19 EVERGLADE CIR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53717-1110
Country	:	US
Telephone Number	:	608-277-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 PRICE PL STE 203
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-3262
Country	:	US
Telephone Number	:	608-277-7601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/03/2022

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