Provider Demographics
NPI:1023383494
Name:GOLD, BRIAN C (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:GOLD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3S159 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7232
Mailing Address - Country:US
Mailing Address - Phone:630-630-3020
Mailing Address - Fax:708-636-8778
Practice Address - Street 1:9730 S WESTERN AVE STE 335
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2759
Practice Address - Country:US
Practice Address - Phone:708-535-7320
Practice Address - Fax:708-535-7571
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0167501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical