Andrew Jonah Gomberg, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.012991 Issued in IL

Practice address

378 Park Ave Ste 2a
Glencoe, IL 60022-2700

Phone

(773) 480-6150

Fax

(847) 242-0795

NPI assigned

Jun 9, 2008

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 9, 2008.

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212969600000",
    "number": "1104085703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 W WINNEMAC AVE UNIT E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407145",
            "telephone_number": "773-480-6150",
            "fax_number": "847-242-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "378 PARK AVE STE 2A",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "600222700",
            "telephone_number": "773-480-6150",
            "fax_number": "847-242-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMBERG",
        "first_name": "ANDREW",
        "middle_name": "JONAH",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.012991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Frank
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• Jennifer Friedman, M.D., LCPC
• Gabriela Garcia
• Green Balance LLC
• Jennifer Erin Gregg, LCSW
• Nina Gelfand Harris, M.A.
• Shari Friedman Hartman
• Jessica Holzman, MSW

• All providers in Glencoe, IL
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.