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NPI Code Detail

MEDICARE: MARC GOLDSTEIN MA, LPC

MEDICARE: MARC GOLDSTEIN MA, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor178.020699IL

General Provider Information

NPI Number : 1093526725
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC GOLDSTEIN MA, LPC
Provider Business Mailing Address
First Line : 633 W NORTH AVE APT 711
Second Line :
City : CHICAGO
State : IL
Zip : 60610-0904
Country : US
Telephone Number : 630-361-3890
Fax Number :
Provider Business Practice Location Address
First Line : 633 W NORTH AVE APT 711
Second Line :
City : CHICAGO
State : IL
Zip : 60610-0904
Country : US
Telephone Number : 630-361-3890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2025
Last Update Date : 01/14/2025

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