Andrew Jonah Gomberg, L.C.S.W.
Social Worker, Clinical in Glencoe, IL. Individual provider (NPI-1).
NPI number1104085703
StatusActive
Last updated in NPPESJun 9, 2008
Details
- NPI
- 1104085703
- Entity type
- Individual (NPI-1)
- Name
- Andrew Jonah Gomberg
- Credential
- L.C.S.W.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 9, 2008
- Last updated
- Jun 9, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 149.012991 | IL | Yes |
Practice location
378 Park Ave Ste 2aGlencoe, IL 60022-2700
Phone 773-480-6150 · Fax 847-242-0795
Mailing address
1807 W Winnemac Ave Unit EChicago, IL 60640-7145
Phone 773-480-6150 · Fax 847-242-0795
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 19 Clinical Social Worker providers in Glencoe · All 138 providers in Glencoe
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