MEDICARE: LILI TATE ITZHAKI

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	1041C0700X	Clinical Social Worker	ACSW89700	CA
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417518630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILI TATE ITZHAKI

Provider Business Mailing Address
First Line	:	752 W END AVE APT 7C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-6232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	752 W END AVE APT 7C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-6232
Country	:	US
Telephone Number	:	646-703-2799
Fax Number	:

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

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	05/25/2026

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Directions to “ LILI TATE ITZHAKI ” Practice Location

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