Katherine Gardner Goetz, LCSW

Individual provider Active NPI Clinical Social Worker · Park Forest, IL

NPI 1043370208 · NPPES record last updated Jul 8, 2007

Key facts

NPI: 1043370208
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
Practice address: 200 Lakewood Blvd
Park Forest, IL 60466-1718
Phone: (708) 481-9799
NPI assigned: Dec 11, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Katherine Goetz Licsw LLC Adolescent and Children Mental Health Clinic/Center · West Burke, VT · NPI 1275252033

NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
149.011293	IL	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Katherine Goetz Licsw LLC		Current	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X		IL	Yes

Addresses

Primary practice location

200 Lakewood Blvd
Park Forest, IL 60466-1718

Mailing address

6635 N Mozart St
Chicago, IL 60645-4307
Phone (773) 262-6133

Other providers in Park Forest, IL

All providers in Park Forest, IL · Clinical Social Worker in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.