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General NPI Number Information
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NPI Number | 1659485878
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Entity Type | Organization
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Legal Business Name | DAVID GOODMAN, PH.D. PSYCHOLOGIST LTD.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 2075 FOXFIELD RD STE 202
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City | ST CHARLES
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State | IL
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Zip | 60174-1402
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Country | US
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Telephone | 630-377-3535
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Fax | 630-377-6703
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Provider Business Mailing Address
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Address Line | 2075 FOXFIELD RD STE 202
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City | ST CHARLES
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State | IL
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Zip | 60174-1402
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Country | US
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Telephone | 630-377-3535
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Fax | 630-377-6703
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MELISSA COSME
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Credential |
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Telephone | 630-377-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071002731
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License Number State | IL
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