Healthcare Provider Details

I. General information

NPI: 1295653863
Provider Name (Legal Business Name): REBECCA L GOLD-STEIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD STE 1632
CHICAGO IL
60604-3734
US

IV. Provider business mailing address

3644 N HERMITAGE AVE APT 2
CHICAGO IL
60613-5155
US

V. Phone/Fax

Practice location:
  • Phone: 312-772-6141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: