Healthcare Provider Details

I. General information

NPI: 1386745339
Provider Name (Legal Business Name): AVIHU GREENE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 LAKE COOK RD SUITE 206
NORTHBROOK IL
60062-1447
US

IV. Provider business mailing address

1535 LAKE COOK RD SUITE 206
NORTHBROOK IL
60062-1447
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-7880
  • Fax:
Mailing address:
  • Phone: 847-480-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: