Provider Demographics
NPI:1659340776
Name:GOLDWASSER, RICHARD (PH D LCPC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GOLDWASSER
Suffix:
Gender:M
Credentials:PH D LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 OAKWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8296
Mailing Address - Country:US
Mailing Address - Phone:847-883-8834
Mailing Address - Fax:312-337-2272
Practice Address - Street 1:203 N WABASH AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-2417
Practice Address - Country:US
Practice Address - Phone:312-444-1777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001278103T00000X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1633146OtherANTHEM BC BS
62862OtherCIGNA