MEDICARE: MS. TAMARA JUDITH GITTELSON MA

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	101YM0800X	Mental Health Counselor	180.008767	IL
2	102L00000X	Psychoanalyst	180.008767	IL
3	101YP2500X	Professional Counselor	180.008767	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629688254	OTHER	IL	NPI TYPE 2

General Provider Information

NPI Number	:	1942506381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA JUDITH GITTELSON MA

Provider Business Mailing Address
First Line	:	2773 N HAMPDEN CT APT 502
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2333
Country	:	US
Telephone Number	:	206-351-6555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 N RAVENSWOOD AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1192
Country	:	US
Telephone Number	:	206-351-2655
Fax Number	:

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

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	04/21/2025

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