Provider Demographics
NPI:1881296820
Name:GOLDMAN, DANIELLE FINE (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:FINE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9525 BRYN MAWR AVE STE 955
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5249
Mailing Address - Country:US
Mailing Address - Phone:847-778-9936
Mailing Address - Fax:
Practice Address - Street 1:9525 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-5249
Practice Address - Country:US
Practice Address - Phone:847-778-9936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0098071041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist