Provider Demographics
NPI:1932283736
Name:GOLDEN, BERNARD ROBERT
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:ROBERT
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W WELLINGTON AVE APT 7D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5631
Mailing Address - Country:US
Mailing Address - Phone:773-665-1666
Mailing Address - Fax:
Practice Address - Street 1:360 W WELLINGTON AVE APT 7D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5631
Practice Address - Country:US
Practice Address - Phone:773-665-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical