Healthcare Provider Details

I. General information

NPI: 1821141995
Provider Name (Legal Business Name): KATHERINE N GOLDBERG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MARION ST
OAK PARK IL
60302-2809
US

IV. Provider business mailing address

50 LAKE ST
OAK PARK IL
60302-2635
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-7500
  • Fax:
Mailing address:
  • Phone: 708-837-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: