Corrie Adina Goldberg, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.009961 Issued in IL

Practice address

1189 Wilmette Ave # 174
Wilmette, IL 60091-2719

Phone

(847) 558-1546

NPI assigned

Feb 2, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 14, 2019 through Aug 14, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Shore Therapy Center for Wellness, LLC

  • Clinical Psychologist
  • Wilmette, IL
  • NPI 1063067866
  NPD Authorized official
• Shore Therapy Center for Wellness, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wilmette, IL
  • NPI 1285385617
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1821553934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 MARION AVE",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600355130",
            "telephone_number": "847-558-1546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1189 WILMETTE AVE # 174",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912719",
            "telephone_number": "847-558-1546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "CORRIE",
        "middle_name": "ADINA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-02",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071.009961",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sari Glazebrook
• Aleksandar Glisovic
• Gloria Levin and Associates
• Dale Susan Gody, PH.D.
• Carol S Goldbaum, PH.D., LCSW
• Eugene M Goldberg, D.D.S.
• Edi Claire Golden-Gruber, LCSW
• Lisa Goldman, LCPC
• Thomas Joseph Golebiewski Sr.
• Alexandra Golub, LSW

• Clinical Psychologist in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.