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NPI Code Detail

MEDICARE: TOVA GOTTLIEB

MEDICARE:   TOVA  GOTTLIEB
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
11041C0700XClinical Social Worker149.024598IL

General Provider Information

NPI Number : 1801528138
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOVA GOTTLIEB
Provider Business Mailing Address
First Line : 4809 N RAVENSWOOD AVE # 420
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4495
Country : US
Telephone Number : 872-235-8659
Fax Number :
Provider Business Practice Location Address
First Line : 4809 N RAVENSWOOD AVE # 420
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4495
Country : US
Telephone Number : 872-235-8659
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2022
Last Update Date : 11/08/2023

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Directions to “ TOVA GOTTLIEB ” Practice Location

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