| Coast To Coast Lcsw Pllc | |
|
208 N Meadow St Unit 2 Ithaca NY 14850-4027 | |
| (607) 319-3036 | |
| Not Available |
| Full Name | Coast To Coast Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 208 N Meadow St Unit 2, Ithaca, New York |
| Authorized Official Name and Position | Julie Ann Tatowicz (OWNER) |
| Authorized Official Contact | 6073193036 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coast To Coast Lcsw Pllc Po Box 4804 Ithaca NY 14852-4804 Ph: (607) 319-3036 | Coast To Coast Lcsw Pllc 208 N Meadow St Unit 2 Ithaca NY 14850-4027 Ph: (607) 319-3036 |
| NPI Number | 1861120628 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 08/10/2022 |
| Certification Date | 08/10/2022 |
| Medicare PECOS PAC ID | 5890171748 |
|---|---|
| Medicare Enrollment ID | O20220930000693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861120628 | NPI | - | NPPES |
| 1487994570 | Other | NY | PERSONAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Julie Ann Tatowicz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487994570 PECOS PAC ID: 8426314717 Enrollment ID: I20220930000549 |
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