Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
N | 1041C0700X | Clinical Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | IL |
NPI | 1023614864 |
---|---|
Provider Name | Dr. Carolyn Ann Goosby |
First Address | Justice, IL 60458 |
Second Address | Oak Lawn, IL 60453-3005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2020 |
Last Update Date | 08/12/2020 |