Active NPI
Michele Itskowitch, LICENSED CLINICAL SO
- Clinical Social Worker
- Ny, NY
National Provider Identifier
1538296165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 052879
- Practice address
- 1155 Park Avenue
Medical Suite B
Ny, NY 10128 - Phone
- (212) 734-5491
- Fax
- (212) 987-8466
- NPI assigned
- Feb 28, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 052879 | NY | Primary |
Addresses
Primary practice location
1155 Park Avenue
Medical Suite B
Ny, NY 10128
Mailing address
160 E 84 Street
Apt 15G
Ny, NY 10028
Phone (212) 734-5491
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P2540129 | Other | NY | OXFORD INS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538296165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 E 84 STREET",
"address_2": "APT 15G",
"city": "NY",
"state": "NY",
"postal_code": "10028",
"telephone_number": "212-734-5491",
"fax_number": "212-987-8466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 PARK AVENUE",
"address_2": "MEDICAL SUITE B",
"city": "NY",
"state": "NY",
"postal_code": "10128",
"telephone_number": "212-734-5491",
"fax_number": "212-987-8466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ITSKOWITCH",
"first_name": "MICHELE",
"name_prefix": "Ms.",
"credential": "LICENSED CLINICAL SO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "052879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD INS",
"identifier": "P2540129",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ny, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.