MICHIGAN AVENUE NEUROPSYCHOLOGISTS
NPI 1063568210
Clinical Neuropsychologist in Chicago, IL
NPI Status: Active since January 28, 2007
Contact Information
200 S MICHIGAN AVE
SUITE 710
CHICAGO, IL
ZIP 60604
Phone: (312) 212-1776
Fax: (312) 212-1778
- Organization
- Clinical Neuropsychologist
- CLIA Number: 14D0694244
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 03-21-2026
About MICHIGAN AVENUE NEUROPSYCHOLOGISTS
This page provides the complete NPI Profile along with additional information for Michigan Avenue Neuropsychologists, a provider established in Chicago, Illinois operating as a Clinical Neuropsychologist. The healthcare provider is registered in the NPI registry with number 1063568210 assigned on January 2007. The practitioner's primary taxonomy code is 103G00000X with license number 071006006 (IL). The provider is registered as an organization and their NPI record was last updated 17 years ago. Michigan Avenue Neuropsychologists operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Michigan Avenue Neuropsychologists. The authorized official of this NPI record is Dr. Diana Susan Goldstein Ph.d., Abpp (President & Ceo)
- NPI
- 1063568210
- Provider Legal Name
- GOLDSTEIN NEUROPSYCHOLOGISTS PC
- Other Organization Name
- MICHIGAN AVENUE NEUROPSYCHOLOGISTS
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 200 S MICHIGAN AVE SUITE 710 CHICAGO, IL 60604
- Location Phone
- (312) 212-1776
- Location Fax
- (312) 212-1778
- Mailing Address
- 200 S MICHIGAN AVE SUITE 710 CHICAGO, IL 60604
- Mailing Phone
- (312) 212-1776
- Mailing Fax
- (312) 212-1778
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-28-2007
- Last Update Date
- 06-08-2009
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinical Neuropsychologist
- Taxonomy Code
- 103G00000X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 071006006
- License State
- IL
- Taxonomy Description
- A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 20041441A (IN) |
| 2 | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | 071006006 (IL) |
| 3 | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | 20041441A (IN) |
| 4 | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | 071006006 (IL) |
| 5 | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | 20041441A (IN) |
| 6 | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | 071006006 (IL) |
| 7 | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | 20041441A (IN) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D0694244
- Facility Type
- Physician Office
- Certificate Effective Date
- March 22, 2024
- Certificate Expiration Date
- March 21, 2026
- Laboratory Director
- SHIRLEY TER MOLEN MD
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Michigan Avenue Neuropsychologists to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for MICHIGAN AVENUE NEUROPSYCHOLOGISTS
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1063568210, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 50. The final step is to find the difference between that total and the next multiple of ten (50 - 50 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 50 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
CHICAGO, IL 60604
CHICAGO, IL 60604
CHICAGO, IL 60604
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063568210, enumerated as an "organization" on January 28, 2007.
The provider is located at 200 S MICHIGAN AVE SUITE 710 CHICAGO, IL 60604 and the phone number is (312) 212-1776.
Clinical Neuropsychologist with taxonomy code 103G00000X.
