MEDICARE: DR. JACOB ZE'EV BARNETT GOLDSMITH PH.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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1700145331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB ZE'EV BARNETT GOLDSMITH PH.D.

Provider Business Mailing Address
First Line	:	2652 W COYLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2652 W COYLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3215
Country	:	US
Telephone Number	:	773-354-2652
Fax Number	:

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

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	10/26/2021

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