Healthcare Provider Details

I. General information

NPI: 1487263729
Provider Name (Legal Business Name): ELIZABETH GOODMAN PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E LAKE ST STE 1A
ADDISON IL
60101-2877
US

IV. Provider business mailing address

120 KIMBERLY LN
LAKE FOREST IL
60045-3889
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-5196
  • Fax:
Mailing address:
  • Phone: 502-544-2192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELIZABETH GOODMAN
Title or Position: LCSW
Credential:
Phone: 502-544-2192