Healthcare Provider Details

I. General information

NPI: 1508429838
Provider Name (Legal Business Name): ABIGAIL C GOLDBERG MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 N MEACHAM RD STE 750
SCHAUMBURG IL
60173-4368
US

IV. Provider business mailing address

1940 LINDEN AVE
HIGHLAND PARK IL
60035-2512
US

V. Phone/Fax

Practice location:
  • Phone: 612-432-1806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: