Healthcare Provider Details

I. General information

NPI: 1841453214
Provider Name (Legal Business Name): PATRICIA GOBEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 DUNDEE RD SUITE 411
NORTHBROOK IL
60062-2422
US

IV. Provider business mailing address

418 GROUSE LN
DEERFIELD IL
60015-3621
US

V. Phone/Fax

Practice location:
  • Phone: 847-205-0371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149011463
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: