Provider Demographics
NPI:1063568210
Name:GOLDSTEIN NEUROPSYCHOLOGISTS PC
Entity type:Organization
Organization Name:GOLDSTEIN NEUROPSYCHOLOGISTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:312-212-1776
Mailing Address - Street 1:200 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2402
Mailing Address - Country:US
Mailing Address - Phone:312-212-1776
Mailing Address - Fax:312-212-1778
Practice Address - Street 1:200 S MICHIGAN AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2402
Practice Address - Country:US
Practice Address - Phone:312-212-1776
Practice Address - Fax:312-212-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041441A103G00000X, 103TA0700X, 103TC0700X, 103T00000X
IL071006006103TA0700X, 103TC0700X, 103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty