Provider Demographics
NPI:1962039974
Name:RICHARD N. GOODMAN, LCPC, LTD.
Entity Type:Organization
Organization Name:RICHARD N. GOODMAN, LCPC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-650-1761
Mailing Address - Street 1:1003 LONGAKER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3921
Mailing Address - Country:US
Mailing Address - Phone:847-650-1995
Mailing Address - Fax:
Practice Address - Street 1:4801 W PETERSON AVE STE 403
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5727
Practice Address - Country:US
Practice Address - Phone:847-650-1995
Practice Address - Fax:847-469-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL321585345001Medicaid