Healthcare Provider Details

I. General information

NPI: 1427272368
Provider Name (Legal Business Name): MICHELLE ANNE GREEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CRYSTAL POINT DR SUITE 3
CRYSTAL LAKE IL
60014-1401
US

IV. Provider business mailing address

2615 THREE OAKS RD STE 2B
CARY IL
60013-6119
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-2270
  • Fax: 815-477-2287
Mailing address:
  • Phone: 224-523-0769
  • Fax: 888-972-5628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149011403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: