Provider Demographics
NPI:1053616573
Name:GOLDSTEIN, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E BURR OAK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1919
Mailing Address - Country:US
Mailing Address - Phone:847-372-0643
Mailing Address - Fax:
Practice Address - Street 1:545 LINCOLN AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2349
Practice Address - Country:US
Practice Address - Phone:847-372-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0120261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical