Provider Demographics
NPI:1598040941
Name:GOODMAN, RICHARD (LCPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 DEERFIELD RD
Mailing Address - Street 2:1-S
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4103
Mailing Address - Country:US
Mailing Address - Phone:847-444-0107
Mailing Address - Fax:
Practice Address - Street 1:939 DEERFIELD RD
Practice Address - Street 2:1-S
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4103
Practice Address - Country:US
Practice Address - Phone:847-444-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional