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NPI Code Detail

MEDICARE: DR. JORDANA GOLDSTEIN PSY.D.

MEDICARE: DR. JORDANA GOLDSTEIN 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
1103TC0700XClinical Psychologist071007705IL

General Provider Information

NPI Number : 1861623423
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORDANA GOLDSTEIN PSY.D.
Provider Business Mailing Address
First Line : 2385 N. SHEFFIELD AVE
Second Line : SUITE 407
City : CHICAGO
State : IL
Zip : 60657-5081
Country : US
Telephone Number : 312-505-0677
Fax Number :
Provider Business Practice Location Address
First Line : 2385 N. SHEFFIELD AVE
Second Line : SUITE 407
City : CHICAGO
State : IL
Zip : 60657-5081
Country : US
Telephone Number : 312-505-0677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2009
Last Update Date : 05/01/2013

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