Provider Demographics
NPI:1437427317
Name:GOLDENSTEIN, RYAN THOMAS (PSYD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:GOLDENSTEIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W WASHINGTON ST STE 320
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8256
Mailing Address - Country:US
Mailing Address - Phone:630-881-8388
Mailing Address - Fax:630-882-5355
Practice Address - Street 1:123 W WASHINGTON ST STE 320
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8256
Practice Address - Country:US
Practice Address - Phone:630-881-8388
Practice Address - Fax:630-882-5355
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5653103TC0700X
IL071.010019103TC0700X
AZ4214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical