Provider Demographics
NPI:1861623423
Name:GOLDSTEIN, JORDANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JORDANA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JORDANA
Other - Middle Name:
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2385 N. SHEFFIELD AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5081
Mailing Address - Country:US
Mailing Address - Phone:312-505-0677
Mailing Address - Fax:
Practice Address - Street 1:2385 N. SHEFFIELD AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5081
Practice Address - Country:US
Practice Address - Phone:312-505-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical