MEDICARE: EMOTION-FOCUSED THERAPY CHICAGO, LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1104468800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMOTION-FOCUSED THERAPY CHICAGO, LLC

Provider Business Mailing Address
First Line	:	2423 W HURON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1684
Country	:	US
Telephone Number	:	773-592-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 E OHIO ST STE 405
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5288
Country	:	US
Telephone Number	:	773-592-1615
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. RHONDA GOLDMAN
Credential	:	PHD
Telephone Number	:	773-592-1615

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	10/14/2019

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