MEDICARE: DR. AMANDA ALLER GOLDMAN PHD, 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	180005461	IL
2	101YP2500X	Professional Counselor	180005461	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	119856343168	OTHER		HUMANA
2	0001634918	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1811090343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA ALLER GOLDMAN PHD, LCPC

Provider Business Mailing Address
First Line	:	146 SOUTH LINCOLN AVENUE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60505-4236
Country	:	US
Telephone Number	:	630-892-3844
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 CHURCH RD
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-9745
Country	:	US
Telephone Number	:	630-486-3800
Fax Number	:	630-486-3800

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	03/06/2025

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