Healthcare Provider Details

I. General information

NPI: 1831726355
Provider Name (Legal Business Name): HANNAH GREEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

1606 W WINONA ST APT 1
CHICAGO IL
60640-2744
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-5380
  • Fax:
Mailing address:
  • Phone: 617-750-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018679
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: