Provider Demographics
NPI:1811090343
Name:GOLDMAN, AMANDA ALLER (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ALLER
Last Name:GOLDMAN
Suffix:
Gender:
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ALLER
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 SOUTH LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4236
Mailing Address - Country:US
Mailing Address - Phone:630-892-3844
Mailing Address - Fax:
Practice Address - Street 1:2755 CHURCH RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9745
Practice Address - Country:US
Practice Address - Phone:630-486-3800
Practice Address - Fax:630-486-3800
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005461103T00000X, 101YP2500X, 106H00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
119856343168OtherHUMANA
IL0001634918OtherBLUE CROSS BLUE SHIELD