Provider Demographics
NPI:1033435110
Name:GOLDMAN, WENDY ANNE (MSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANNE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2949
Mailing Address - Country:US
Mailing Address - Phone:847-508-4577
Mailing Address - Fax:
Practice Address - Street 1:1213 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-2949
Practice Address - Country:US
Practice Address - Phone:847-508-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0073081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical