Healthcare Provider Details

I. General information

NPI: 1154424471
Provider Name (Legal Business Name): MARK LLOYD GOLDSTEIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 SHERIDAN RD SUITE 215
HIGHLAND PARK IL
60035
US

IV. Provider business mailing address

1893 SHERIDAN RD SUITE 215
HIGHLAND PARK IL
60035
US

V. Phone/Fax

Practice location:
  • Phone: 847-926-0390
  • Fax: 847-498-8922
Mailing address:
  • Phone: 847-926-0390
  • Fax: 847-498-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number712066
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number712066
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: