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General NPI Number Information
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NPI Number | 1659340776
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Entity Type | Individual
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Provider Name | RICHARD GOLDWASSER PH D LCPC
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 203 N WABASH AVE SUITE 2000
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City | CHICAGO
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State | IL
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Zip | 60601-2417
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Country | US
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Telephone | 312-444-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 5636 OAKWOOD CIRCLE
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City | LONG GROVE
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State | IL
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Zip | 60047-8296
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Country | US
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Telephone | 847-883-8834
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Fax | 312-337-2272
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 001278
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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