MEDICARE: DR. TOBRINA MARCELLA GOLDBAUM PSY.D.

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
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	103TP2701X	Group Psychotherapy Psychologist
4	103TC0700X	Clinical Psychologist	071-008-220	IL

General Provider Information

NPI Number	:	1467766709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOBRINA MARCELLA GOLDBAUM PSY.D.

Provider Business Mailing Address
First Line	:	1043 RIDGEWOOD DR
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4023
Country	:	US
Telephone Number	:	847-701-4378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 RIDGEWOOD DR
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4023
Country	:	US
Telephone Number	:	847-701-4378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	03/17/2018

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