Provider Demographics
NPI:1962039974
Name:RICHARD N. GOODMAN, LCPC, LTD.
Entity type:Organization
Organization Name:RICHARD N. GOODMAN, LCPC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-650-1995
Mailing Address - Street 1:301 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1103
Mailing Address - Country:US
Mailing Address - Phone:847-650-1995
Mailing Address - Fax:847-650-1995
Practice Address - Street 1:7101 N CICERO AVE STE 203
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2144
Practice Address - Country:US
Practice Address - Phone:847-650-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL321585345001Medicaid