Provider Demographics
NPI:1578605788
Name:GOLDIN, DIANNE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:DEANA
Other - Middle Name:
Other - Last Name:GOLDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:2744 W SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3819
Mailing Address - Country:US
Mailing Address - Phone:312-731-7919
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1516
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-731-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health