Provider Demographics
NPI:1861777898
Name:GOLDSCHMIDT, ANDREA BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:BETH
Last Name:GOLDSCHMIDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:BETH
Other - Last Name:SCHNUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 3077
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-834-4118
Mailing Address - Fax:773-702-9929
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 3077
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-4118
Practice Address - Fax:773-702-9929
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical