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General NPI Number Information
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NPI Number | 1053616573
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Entity Type | Individual
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Provider Name | JENNIFER GOLDSTEIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 545 LINCOLN AVE SUITE 15
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City | WINNETKA
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State | IL
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Zip | 60093-2349
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Country | US
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Telephone | 847-372-0643
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Fax |
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Provider Business Mailing Address
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Address Line | 103 E BURR OAK DR
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City | ARLINGTON HTS
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State | IL
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Zip | 60004-1919
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Country | US
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Telephone | 847-372-0643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-012026
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License Number State | IL
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