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NPI Code Detail

MEDICARE: LEAH GOLDGAR MA, LPC, NCC

MEDICARE: LEAH GOLDGAR MA, LPC, NCC
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
1101YP2500XProfessional Counselor178.014153IL

General Provider Information

NPI Number : 1700351178
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH GOLDGAR MA, LPC, NCC
Provider Business Mailing Address
First Line : 1507 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4702
Country : US
Telephone Number : 773-569-1468
Fax Number :
Provider Business Practice Location Address
First Line : 1507 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4702
Country : US
Telephone Number : 773-754-7441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2018
Last Update Date : 09/15/2020

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