Provider Demographics
NPI:1932283736
Name:GOLDEN, BERNARD ROBERT
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:ROBERT
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WELLINGTON AVE
Mailing Address - Street 2:9B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-665-1666
Mailing Address - Fax:
Practice Address - Street 1:1 EAST DELAWARE PLACE
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4962
Practice Address - Country:US
Practice Address - Phone:312-642-0265
Practice Address - Fax:312-280-8365
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical