Provider Demographics
NPI:1023614864
Name:GOOSBY, CAROLYN ANN (DMIN, MDIV, LCSW)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:GOOSBY
Suffix:
Gender:F
Credentials:DMIN, MDIV, LCSW
Other - Prefix:
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Mailing Address - Street 1:DR CAROLYN A GOOSBY
Mailing Address - Street 2:8108A CONCORD LANE
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458
Mailing Address - Country:US
Mailing Address - Phone:773-507-3770
Mailing Address - Fax:708-563-0114
Practice Address - Street 1:9701 S 49TH AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3005
Practice Address - Country:US
Practice Address - Phone:773-507-3770
Practice Address - Fax:708-563-0114
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 1041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral