MEDICARE: DR. RICHARD GOLDWASSER PH D LCPC

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	103T00000X	Psychologist	001278	CT
2	101YP2500X	Professional Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1633146	OTHER		ANTHEM BC BS
2	62862	OTHER		CIGNA

General Provider Information

NPI Number	:	1659340776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GOLDWASSER PH D LCPC

Provider Business Mailing Address
First Line	:	5636 OAKWOOD CIRCLE
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-8296
Country	:	US
Telephone Number	:	847-883-8834
Fax Number	:	312-337-2272

Provider Business Practice Location Address
First Line	:	203 N WABASH AVE
Second Line	:	SUITE 2000
City	:	CHICAGO
State	:	IL
Zip	:	60601-2417
Country	:	US
Telephone Number	:	312-444-1777
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	09/11/2025

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