MEDICARE: TATYANA TIMOFF-KISSIN LCSW

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	R045989-1	NY

General Provider Information

NPI Number	:	1578592200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATYANA TIMOFF-KISSIN LCSW

Provider Business Mailing Address
First Line	:	15 W 72ND ST APT 1E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-3419
Country	:	US
Telephone Number	:	917-680-6121
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 W 72ND ST APT 1E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-3419
Country	:	US
Telephone Number	:	917-680-6121
Fax Number	:

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/10/2015

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