Healthcare Provider Details

I. General information

NPI: 1376751164
Provider Name (Legal Business Name): ROBYN LESLIE GOLDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SOUTH PAULINA AVE SUITE 422
CHICAGO IL
60612
US

IV. Provider business mailing address

6233 N WAYNE AVE
CHICAGO IL
60660-1912
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4436
  • Fax: 312-942-3601
Mailing address:
  • Phone: 312-942-4436
  • Fax: 312-942-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number159-00187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: