Provider Demographics
NPI:1093526725
Name:GOLDSTEIN, MARC (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 W NORTH AVE APT 711
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-0904
Mailing Address - Country:US
Mailing Address - Phone:630-361-3890
Mailing Address - Fax:
Practice Address - Street 1:633 W NORTH AVE APT 711
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-0904
Practice Address - Country:US
Practice Address - Phone:630-361-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health