Provider Demographics
NPI:1801592639
Name:GOLDMAN, DEEDEE (LCSW)
Entity type:Individual
Prefix:
First Name:DEEDEE
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:BLOCK
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:598 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2331
Mailing Address - Country:US
Mailing Address - Phone:847-951-4841
Mailing Address - Fax:
Practice Address - Street 1:707 LAKE COOK RD STE 105
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4909
Practice Address - Country:US
Practice Address - Phone:866-220-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.0041481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty