MEDICARE: ELIZABETH POLTORATSKY

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
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568054344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH POLTORATSKY

Provider Business Mailing Address
First Line	:	878 S WEST AVE
Second Line	:
City	:	WAUKEGAN
State	:	IL
Zip	:	60085-8665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 N KIMBALL AVE # 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4805
Country	:	US
Telephone Number	:	347-909-1902
Fax Number	:

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

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	10/21/2025

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